Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
J Vasc Surg. 2020 Sep;72(3):943-950. doi: 10.1016/j.jvs.2019.10.093. Epub 2020 Jan 19.
The goal of this study was to determine the incidence of postoperative urinary retention (POUR) in men after carotid endarterectomy (CEA) and to identify preventable risk factors for the development of this complication.
All male patients who underwent CEA from 2014 to June 2018 were identified. Exclusions included CEA with concomitant cardiac surgery, baseline dialysis, and indwelling or straight catheterization. POUR was the primary end point, defined as inability to void requiring catheterization within 24 hours postoperatively or after removal of a preoperatively placed Foley catheter. POUR was further classified as mild (single catheterization), moderate (multiple catheterizations), or severe (catheterization prolonging discharge or discharge with catheter). Logistic regression assessed for POUR risk factors.
There were 294 male patients who underwent CEA during the study period; 82 (28.2%) developed POUR. Of these, 48 (57.8%) were mild, 15 (18.1%) were moderate, and 20 (24.1%) were severe. At baseline, POUR was associated with older age, peripheral artery disease (PAD), chronic kidney disease, diabetes, ambulation deficit, prior urinary retention, and statin and chronic tamsulosin use. Overall, 31.6% (93) of the cohort had a Foley catheter placed before the procedure, and this was protective against POUR (no Foley vs Foley, 31.8% vs 20.4%; P = .043). Independent risk factors for POUR included prior urinary retention (odds ratio [OR], 3.4 [1.6-7.3]; P = .002), diabetes (OR, 2.1 [1.1-3.7]; P = .016), PAD (OR, 2.3 [1.1-5.2]; P = .036), and age (per year: OR, 1.1 [1.02-1.10]; P < .001). Preoperative Foley catheter placement remained protective (OR, 0.4 [0.2-0.7]; P = .003). Preoperative Foley catheter placement was not associated with urinary tract infection (preoperative Foley catheter: 0% vs 1%; P = .54). However, POUR was associated with an increased risk for urinary tract infections (10% vs 1%; P = .001), which was highest in severe POUR (20% vs 1%; P = .001). POUR was also associated with a discharge to rehabilitation (16% vs 4%; P = .002), with highest rates in the moderate and severe POUR cohorts (20% each).
POUR is common in men undergoing CEA, and almost a quarter of those with POUR have a discharge delay or are discharged with a Foley catheter. Preoperative Foley catheterization is protective against POUR and should be considered in older patients, diabetics, patients with PAD, and those with a history of urinary retention.
本研究旨在确定男性颈动脉内膜切除术（CEA）后术后尿潴留（POUR）的发生率，并确定该并发症发生的可预防的危险因素。
确定了 2014 年至 2018 年 6 月期间接受 CEA 的所有男性患者。排除标准包括 CEA 合并心脏手术、基线透析以及留置或直导管。POUR 是主要终点，定义为术后 24 小时内或术前放置的 Foley 导管移除后无法排尿需要导管插入术。POUR 进一步分为轻度（单次导管插入术）、中度（多次导管插入术）或重度（导管插入术延长出院或带导管出院）。Logistic 回归评估 POUR 危险因素。
研究期间共有 294 名男性接受了 CEA；82 人（28.2%）发生了 POUR。其中 48 人（57.8%）为轻度，15 人（18.1%）为中度，20 人（24.1%）为重度。基线时，POUR 与年龄较大、外周动脉疾病（PAD）、慢性肾脏病、糖尿病、活动能力缺陷、既往尿潴留以及他汀类药物和慢性坦索罗辛的使用有关。总体而言，该队列中有 31.6%（93 人）在术前放置了 Foley 导管，这对 POUR 具有保护作用（无 Foley 导管 vs Foley 导管，31.8% vs 20.4%；P =.043）。POUR 的独立危险因素包括既往尿潴留（比值比[OR]，3.4 [1.6-7.3]；P =.002）、糖尿病（OR，2.1 [1.1-3.7]；P =.016）、PAD（OR，2.3 [1.1-5.2]；P =.036）和年龄（每年：OR，1.1 [1.02-1.10]；P ＜.001）。术前 Foley 导管的放置仍然具有保护作用（OR，0.4 [0.2-0.7]；P =.003）。术前 Foley 导管的放置与尿路感染无关（术前 Foley 导管：0% vs 1%；P =.54）。然而，POUR 与尿路感染的风险增加有关（10% vs 1%；P =.001），在重度 POUR 中风险最高（20% vs 1%；P =.001）。POUR 还与康复出院有关（16% vs 4%；P =.002），在中度和重度 POUR 队列中发生率最高（各 20%）。
POUR 在接受 CEA 的男性中很常见，近四分之一的 POUR 患者有出院延迟或带 Foley 导管出院。术前 Foley 导管插入术对 POUR 有保护作用，应考虑在老年患者、糖尿病患者、PAD 患者和有尿潴留病史的患者中使用。
