Altschul David, Kobets Andrew, Nakhla Jonathan, Jada Ajit, Nasser Rani, Kinon Merritt D, Yassari Reza, Houten John
Department of Neurosurgery, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York; and.
Marcus Neuroscience Institute, Boca Raton, Florida.
J Neurosurg Spine. 2017 Feb;26(2):229-234. doi: 10.3171/2016.8.SPINE151371. Epub 2016 Oct 21.
OBJECTIVE Postoperative urinary retention (POUR) is a common problem leading to morbidity and an increased hospital stay. There are limited data regarding its baseline incidence in patients undergoing spinal surgery and the risk factors with which it may be associated. The purpose of this study was to evaluate the incidence of POUR in elective spine surgery patients and determine the factors associated with its occurrence. METHODS The authors retrospectively reviewed the records of patients who had undergone elective spine surgery and had been prospectively monitored for POUR during an 18-month period. Collected data included operative positioning, surgery duration, volume of intraoperative fluid, length of hospital stay, and patient characteristics such as age, sex, and medical comorbidities. Dialysis patients or those with complete urinary retention preoperatively were excluded from analysis. RESULTS Of the 397 patients meeting the study inclusion criteria, 35 (8.8%) developed POUR. An increased incidence of POUR was noted in those who underwent posterior lumbar surgery, those with benign prostatic hypertrophy (BPH), those with chronic constipation or prior urinary retention, and those using a patient-controlled analgesia pump postoperatively. An increased incidence of POUR was seen with a longer operative time but not with intraoperative intravenous fluid administration. A significant relationship between the female sex and POUR was noted after controlling for BPH, yet there was no association between POUR and diabetes or intraoperative instrumentation. Postoperative retention significantly prolonged the hospital stay. Three patients developed epidural hematomas necessitating operative reexploration, and while they experienced POUR, they also developed the full constellation of cauda equina syndrome. CONCLUSIONS Awareness of the risk factors for POUR may be useful in perioperative Foley catheter management and in identifying patients who need particular vigilance when they are due to void postprocedure. A greater understanding of POUR may also prevent longer hospital stays in select at-risk patients. Postoperative retention is rarely caused by a postoperative cauda equina syndrome due to epidural hematoma, which is also associated with saddle anesthesia, leg pain, and weakness, yet the delineation of isolated POUR from this urgent complication is necessary for optimal patient care.
目的 术后尿潴留（POUR）是一个导致发病和住院时间延长的常见问题。关于其在脊柱手术患者中的基线发病率以及可能与之相关的危险因素的数据有限。本研究的目的是评估择期脊柱手术患者中POUR的发生率，并确定与其发生相关的因素。方法 作者回顾性分析了在18个月期间接受择期脊柱手术并对POUR进行前瞻性监测的患者记录。收集的数据包括手术体位、手术持续时间、术中液体量、住院时间以及患者特征，如年龄、性别和合并症。透析患者或术前完全尿潴留的患者被排除在分析之外。结果 在符合研究纳入标准的397例患者中，35例（8.8%）发生了POUR。接受后路腰椎手术的患者、患有良性前列腺增生（BPH）的患者、患有慢性便秘或既往有尿潴留的患者以及术后使用患者自控镇痛泵的患者中，POUR的发生率增加。手术时间延长会导致POUR发生率增加，但术中静脉输液量增加与POUR发生率无关。在控制BPH后，发现女性与POUR之间存在显著关系，但POUR与糖尿病或术中器械使用之间没有关联。术后尿潴留显著延长了住院时间。3例患者发生硬膜外血肿，需要进行手术再次探查，虽然他们发生了POUR，但也出现了马尾综合征的全部症状。结论 了解POUR的危险因素可能有助于围手术期导尿管管理，并识别术后排尿时需要特别警惕的患者。对POUR有更深入的了解也可能防止部分高危患者住院时间延长。术后尿潴留很少由硬膜外血肿导致的术后马尾综合征引起，硬膜外血肿还与鞍区麻醉、腿痛和无力有关，但为了实现最佳患者护理，区分孤立的POUR与这种紧急并发症是必要的。
