Departments of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
Department of Urology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
Can J Urol. 2022 Jun;29(3):11175-11181.
Bladder spasm are common complications following cystoscopic urologic procedures. This study aims to determine the incidence and risk factors for bladder spasm after ambulatory cystoscopic urologic procedures.
Medical records of adult patients who underwent urologic procedures in our ambulatory center from May 1st, 2018 through December 30th, 2020, were reviewed. Bladder spasm was identified from the administration of antispasmodic therapy (e.g. oxybutynin) during anesthesia recovery. Multivariable analyses were performed to assess the association between bladder spasm and clinical factors.
Included were 2,671 patients, of which 917 (34.3%) developed postoperative bladder spasm, yielding an incidence of 343 (95%CI 325-361) per 1,000 procedures. Risk factors associated with bladder spasm were younger adult age (< 60 years), longer (> 45 minutes) and more complex procedures. Compared to cystoscopy the risk of spasm following transurethral resection of the bladder tumor was OR 4.35 (95%CI 3.22, 5.87) and for transurethral resection of the prostate OR 3.25 (95% CI 2.24, 4.71). Spasm prophylaxis with belladonna and opium suppositories (B&O) was used in 1,158 patients and 384 (33.2%) developed spasms. The use of B&O was not associated with reduction of bladder spasm, OR 0.91 (95%CI 0.75, 1.1, p = 0.318). Postoperative outcomes did not differ between patients who did or did not develop spasms.
Bladder spasms are common following ambulatory urologic procedures, more so with more extensive procedures. Prophylaxis with B&O was not significantly associated with a lower rate of bladder spasms.
膀胱痉挛是经膀胱泌尿科手术后常见的并发症。本研究旨在确定门诊膀胱泌尿科手术后膀胱痉挛的发生率和危险因素。
回顾 2018 年 5 月 1 日至 2020 年 12 月 30 日期间在我们的门诊中心接受泌尿科手术的成年患者的病历。在麻醉恢复期使用抗痉挛治疗（如奥昔布宁）时确定膀胱痉挛。进行多变量分析以评估膀胱痉挛与临床因素之间的关联。
共纳入 2671 例患者，其中 917 例（34.3%）术后发生膀胱痉挛，每 1000 例手术中有 343 例（95%CI 325-361）发生痉挛。与膀胱痉挛相关的危险因素是年龄较小（<60 岁）、手术时间较长（>45 分钟）和更复杂的手术。与膀胱镜检查相比，膀胱肿瘤经尿道切除术的痉挛风险为 OR 4.35（95%CI 3.22，5.87），经尿道前列腺切除术的痉挛风险为 OR 3.25（95%CI 2.24，4.71）。1158 例患者使用颠茄和鸦片栓剂（B&O）预防痉挛，其中 384 例（33.2%）发生痉挛。使用 B&O 与减少膀胱痉挛无关，OR 0.91（95%CI 0.75，1.1，p=0.318）。是否发生痉挛的患者术后结局无差异。
膀胱痉挛是门诊泌尿科手术后常见的并发症，手术范围越大，痉挛越常见。B&O 预防与膀胱痉挛发生率降低无显著相关性。
