National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust Bristol UK.
Population Health Sciences, Bristol Medical School University of Bristol Bristol UK.
BJS Open. 2018 Nov 19;3(1):11-23. doi: 10.1002/bjs5.50114. eCollection 2019 Feb.
Postoperative urinary retention (PO-UR) is an acute and painful inability to void after surgery that can lead to complications and delayed hospital discharge. Standard treatment with a urinary catheter is associated with a risk of infection and can be distressing, undignified and uncomfortable. This systematic review aimed to identify effective interventions for the prevention and treatment of PO-UR that might be alternatives to urinary catheterization.
Electronic databases were searched from inception to September 2017. Randomized trials of interventions for the prevention or treatment of PO-UR were eligible for inclusion. Studies were assessed for risk of bias using the Cochrane (2.0) tool. Two reviewers were involved at all review stages. Where possible, data were pooled using random-effects meta-analysis. The overall quality of the body of evidence was rated using the GRADE approach.
Some 48 studies involving 5644 participants were included. Most interventions were pharmacological strategies to prevent PO-UR. Based on GRADE, there was high-certainty evidence to support replacing morphine in a regional anaesthetic regimen, using alpha-blockers (number needed to treat to prevent one case of PO-UR (NNT) 5, 95 per cent c.i. 5 to 7), the antispasmodic drug drotaverine (NNT 9, 7 to 30) and early postoperative mobilization (NNT 5, 4 to 8) for prevention, and employing hot packs or gauze soaked in warm water for treatment (NNT 2, 2 to 4). Very few studies reported on secondary outcomes of pain, incidence of urinary tract infection or duration of hospital stay.
Promising interventions exist for PO-UR, but they need to be evaluated in randomized trials investigating comparative clinical and cost effectiveness, and acceptability to patients.
术后尿潴留（PO-UR）是手术后急性且疼痛的无法排尿的情况，可能导致并发症和延迟出院。使用导尿管的标准治疗与感染风险相关，并且可能令人痛苦、不体面和不舒服。本系统评价旨在确定预防和治疗 PO-UR 的有效干预措施，这些措施可能替代导尿。
从开始到 2017 年 9 月，电子数据库进行了搜索。预防或治疗 PO-UR 的干预措施的随机试验符合纳入标准。使用 Cochrane（2.0）工具评估研究的偏倚风险。两名审查员在所有审查阶段都参与其中。在可能的情况下，使用随机效应荟萃分析汇总数据。使用 GRADE 方法评估证据体的总体质量。
纳入了 48 项涉及 5644 名参与者的研究。大多数干预措施是预防 PO-UR 的药物策略。基于 GRADE，有高度确定性的证据支持在区域麻醉方案中替代吗啡，使用α受体阻滞剂（预防一例 PO-UR 的需要治疗数（NNT）5，95%置信区间 5 至 7），抗痉挛药物曲托维林（NNT 9，7 至 30）和早期术后活动（NNT 5，4 至 8），以及使用热包或温水中浸泡的纱布进行治疗（NNT 2，2 至 4）。很少有研究报告疼痛、尿路感染发生率或住院时间等次要结局。
PO-UR 存在有前途的干预措施，但需要在评估比较临床和成本效益以及患者可接受性的随机试验中进行评估。
