Importance: Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors. Objective: To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR. Design, setting, and participants: The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR. Exposure: Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia. Main outcomes and measures: The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients. Results: In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72). Conclusions: The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies.
Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair / Croghan, Stefanie M.; Mohan, Helen M.; Breen, Kieran J.; Mcgovern, Ruth; Bennett, Kathleen E.; Boland, Michael R.; Elhadi, Muhammed; Elliott, Jessie A.; Fullard, Anna C.; Lonergan, Peter E.; Mcdermott, Frank; Mehraj, Asif; Pata, Francesco; Quinlan, David M.; Winter, Des C.; Bolger, Jarlath C.; Fleming, Christina A.; Farinelli, Pablo Alberto; Alaniz Alday, Maria Jimena; Avellaneda, Nicolás L.; Goya, María M.; Clementé, Gastón A.; Lopez, Juan Cruz; Proud, David; Shulman, Natassia; Huang, Dora; Jamel, Wael; Gill, Sonia; Arthur, Thomas; Swindon, Daisy; Frank, Amy; Teng, Roy; Chua, Irene; Chong, Nicole; Hannigan, Amy; Srinivasan, Madhu; Al Bastaki, Aysha; Ahmad, Sharifa; Juma, Isam; Yang, Wah; Wang, Huaxi; Jiang, Shuwen; Lincango Naranjo, Eddy P; Dominguez, Carla M; Huilca, Luis F; Negrete Ocampo, Jose R; Nafea, Ahmed; Awad, Ahmed K.; Elbadawy, Merihan A.; Abdulmonem, Aya Abdulilah; Abdelgalil, Mahmoud Shaban; Helmy, Salma Tarek; Abd El-razik, Sally Ahmed; Mabrouk, Laila Raafat; A. Rady, Ahmed Hassan; Shaheen, Ahmed; Ewedah, Moataz; Farag, Marina; Tanas, Yousef; Dean, Yomna; Ghanem, Maha; Asla, Amir F.; Ghatwary, Ahmed M.; Elsadek, Menan A.; Saad, Aalaa; Hassan, Ramy A.; Herdan, Mohamed O.; Nassar, Mahmoud A.; Alaa, Sherif; Khamis, Areej A.; Youssef, Hadeer M. S.; El Sherpiny, Mohamed A.; Shehata, Eslam S. A. M.; Taha, Sandy A.; Zahran, Ahmed A. A. A; Al-Nagdy, Mohamed; Sayed Hafez, Somaya Z. E; Abo Ghanima, Shymaa M.; Farahat, Sherif; Morgan, Fatma M.; Mahfouz, Shaimaa M.; Elfeki, Hossam; Elghadban, Hosam; Shalaby, Mostafa; Shetiwy, Mohamed; Mostafa, Mohamed; Sakr, Ahmad; Elsayed, Ahmed; Sadek, Kareem; Eldeghedi, Maher; Nader, Mohamed; Elsaadany, Reem; Hesham, Yousef; Attiya, Omar; Shaaban, Abdelrahman; Sakr, Yara; Alharazin, Mohammed; Omar, Mohammed A.; Alansary, Marwa N.; Ebada, Mahmoud A.; Abdelfattah, Mohamed S.; El-Taher, Ahmed K.; Ghaith, Hazem S.; Abdelhaleem, Ibrahim A.; Fayed, Notaila M.; Fayed, Laila; Mahmoud, Mohamed K.; Mohamed, Esraa E.; El-Deeb, Amr M.; Mohamed, Islam M.; El kady, Abd Elrahman S.; Abd Al-Fattah, Mohammed; Hassaan, Mohamad; Hegazy, Mohammed G.; Asla, Amir Fathi; Fradelos, Evangelos; Korkolis, Dimitrios; Kavalieratos, George; Manatakis, Dimitrios K.; Tasis, Nikolaos; Ioannidis, Argyrios; Konstantinidis, Michael; Konstantinidou, Sofia; Koukoulis, Georgios; Kalfountzos, Christos; Bouliaris, Konstantinos; Schizas, Dimitrios; Machairas, Nikolaos; Kykalos, Stylianos; Vailas, Michail; Syllaios, Athanasios; Dorovinis, Panagiotis; Kozadinos, Alexandros; Bouchagier, Konstantinos; Mulita, Francesk; Skroubis, Georgios; Maroulis, Ioannis; Chatzimavroudis, Grigorios; Kotoreni, Georgia; Sountoulides, Petros; Agalianos, Christos; Antonopoulou, Maria Ioanna; Ladoukakis, Aristeidis; Nikolouzakis, Taxiarchis K.; Lasithiotakis, Konstantinos; Chrysos, Emmanuel; Xenaki, Sofia; Baili, Efstratia; Liakakos, Theodore; Charalabopoulos, Alexandros; Al-Juaifari, Maytham A.; Zwain, Yasir A.; Himi, Ahmed A.; Aldawoody, Hogir I. R.; Balasubramanian, Ishwarya; Hill, Arnold D. K.; Robb, William B.; Aketch, Martin Safari; Brady, Aaron M. J.; O' Leary, Peter D.; Elliott, Jessie A.; Davis, Niall F.; Creavin, Ben; Ridgway, Paul F.; Barry, Kevin; Kelly, Orlaith; Raftery, Nicola; Davey, Matthew G.; Mclaughlin, Ray P.; Joyce, William P.; Meldon, Aengus; Fullard, Anna; Nugent, Emmeline; Dhannoon, Amenah; Carroll, Paul; O'Brien, Stephen J.; Andrews, Emmet; Foley, Niamh M.; Killeen, Shane; Hechtl, Daniel; O'Riordain, Michael; Conneely, John B.; Hardy, Niall P.; Mcinerney, Niall J.; Kearns, Emma C.; Shanahan, Ben; Kennedy, Czara; Toomey, Desmond; Mansoor, Shabhaz; Ryan, Eanna; Johnston, Sean M.; Lim, Sean T.; Ahonkhai, Irele Ifijeh; Eltagani, Eltahir; Ryan, Odhran K.; Earley, Helen; Garvin, Joseph; Iruthayanathar, Andru Nitharasan; Clancy, Cillian; Fahey, Brian; Rashid, Haroon; Mccormick, Paul; Reynolds, Ian S.; Garrahy, Darragh; Bean, Orlagh; Conlon, Eoin; Winter, Des C.; Molony, Emily; Martin, Sean T.; Hoti, Emir; Stafford, Anthony T.; Hanly, Ann; Maguire, Donal; Ng, Kin Cheung; Wong, Benjamin Ngie Xiong; Mccormack, Tom; Chan, Kin Yik; Peirce, Colin; Coffey, Calvin; Nabi, Nauman; Jacob, Prem Thomas; Dillon, Patrick; Ahmad, Abrar; Neary, Peter; Ryan, Jessica M.; Connelly, Tara M.; Cooke, Fiachra; Mccullough, Peter W.; Pellino, Gianluca; Selvaggi, Lucio; Selvaggi, Francesco; Gallo, Gaetano; Pata, Francesco; Riboni, Cristiana; Danzi, Michele; De Luca, Marcello; Lionetti, Ruggero; Grimaldi, Luciano; Corcione, Francesco; Manigrasso, Michele; Milone, Marco; De Palma, Giovanni Domenico; Biancafarina, Alessia; Mariottini, Valentina; De Prizio, Marco; Solaini, Leonardo; Cavaliere, Davide; Vigutto, Gabriele; Castaldi, Antonio; Palumbo, Alessio; Antropoli, Carmine; Ripetti, Valter; Luffarelli, Paolo; Capolupo, Gabriella T.; Caricato, Marco; Carannante, Filippo; Grassia, Michele; Lucchi, Andrea; Schimera, Antonio; Palomba, Giuseppe; Aprea, Giovanni; Feo, Carlo V.; Fabbri, Nicolò; Torchiaro, Marco; Mazza, Marcodomenico; De Marco, Paolino; Bagaglini, Giulia; Grande, Michele; Lapolla, Pierfrancesco; Mingoli, Andrea; Brachini, Gioia; Pipitone Federico, Nicoletta Sveva; Calabrò, Marcello; Murgese, Alessandra; Aiolfi, Alberto; Mini, Emanuele; Bona, Davide; Patrone, Renato; Nasto, Aurelio; Pertile, Davide; Scabini, Stefano; Soriero, Domenico; Massobrio, Andrea; Deiana, Selene; Carganico, Giacomo; Montuori, Mauro; Pinotti, Enrico; Carrara, Giulia; Lisi, Giorgio; Spoletini, Domenico; Menditto, Rosa; Pace, Marco; Petrucciani, Niccolò; Nigri, Giuseppe; Sasia, Diego; Girardi, Martina; Giraudo, Giorgio; Andreuccetti, Jacopo; Rossi, Stefano; Scorsi, Alessandro; Puccioni, Caterina; Picardi, Biagio; Anastasi, Alessandro; Borreca, Riccardo; Adinolfi, Elvira; Canonico, Giuseppe; Nelli, Tommaso; Carmignani, Francesco; Baldini, Edoardo; Boccia, Olivia; Kersik, Alessia; Fleres, Francesco; Clarizia, Guglielmo; Longhini, Alessandro; Mariani, Nicolo; Balla, Andrea; Lepiane, Pasquale; Petrocca, Sergio; Ranucci, Maria Chiara; Morelli, Luca; Di Franco, Gregorio; Porcelli, Francesco; Guadagni, Simone; Furbetta, Niccolò; Romanzi, Andrea; Milanesi, Maria; Vignati, Barbara; Vannelli, Alberto; Scolaro, Roberta; Putortì, Antonella; Khamees, Almu'Atasim; Almasarweh, Sami A.; Guboug, Ali; Abu-Ismail, Luai; Al-Shami, Khayry; Awadi, Sajeda; Haij, Manal Zain Mohammed; Alrayes, Bourhan M. H.; Al-Kubaisy, Manolia; Rashdan, Mohammad; Abufaraj, Mohammad; Mansour, Hanan; Toubasi, Ahmad A.; Azzam, Muayad; Al-Aydi, Tala; Bsisu, Isam; Khrais, Oweiss; Bani Hani, Mohammad; Daradkeh, Hamza; Jamous, Hussam; Dardour, Mohammad; Msameh, Renad; Alasawdeh, Hadeel; Shumrakh, Saeed K.; Oqdeh, Yahya F.; AL Hamoud, Mohammad A.; Abuleil, Amro; Ababneh, Hazim Sameer Mohammad; Elhadi, Muhammed; Hasan, Wisam A.; Ali, Ebrahim M.; Khalil, El Sharif F.; Abaidalla, Ahmed Faraj; Il Haddad, Haifaa; Amnaina, Mohamed G.; Alabd, Husayn M.; Bahroun, Sumayyah G.; Younes, Eman; Al Sagheir, Eman; Ali, Ali; Khamaj, Malak; Ashfersh, Mohamed; Ekhmaj, Reyad; Abuzeid, Issa A.; Albaraesi, Mohammed N.; Taktuk, Salah S.; Aldressi, Wafa; Eltaeb, Khalid F.; Gomaty, Jamal M.; Bakeer, Hibah Bileid; Alkaseek, Akram Mohammed; Alarabi, Rehab; Gjam, Fatima Z.; Elhajdawe, Fras A. D.; Shuayb, Ahlam M.; Egdeer, Amin; Almugaddami, Ayman; Abdulwahed, Eman A.; Ghmagh, Reem; Alshareea, Entisar; Gidiem, Doaa; Askar, Aamal; Aljamal, Sarah; Deeknah, Abdulqudus; Biala, Marwa; Barka, Sharf; Kamour, Khaula; Alameen, Hind; Abozid, Anwaar; Alsori, Mohamed; Kanna, Sanad; Elgadi, Tahani; Naana, Reyam; Marwan, Abdulrhman; Omar, Osama; Teoh, Jeremy Y. C.; Ahmed Fathil, Ida Nadiah; Adwin, Zainal Z.; Elshami, Mohamedraed; Alvarez-Lozada, Luis Adrian; Durán-Castro, Daniela G.; de la O-Escamilla, Manuel E.; Arrambide-Garza, Francisco J.; Muñoz-Maldonado, Gerardo E.; Quiroga-Garza, Alejandro; El Azzazi, Hind; El Assaad, Yousra; Mrissa, Yassine; Koukou, Mouad; Varghese, Chris; Alqassab, Mohammed K.; Barnes, Tracey; Thompson-Fawcett, Mark W.; Mcguinness, Matthew; Mitchell, Josh; Grinlinton, Megan; Auchterlonie, Rowan; Hasiata, Vilingatoni; Harmston, Christopher; Allen-Brough, Chelsea; Siggins, Lauren; Weeratunga, George; Lin, Anthony; Xu, William; Cook, Holly; Ghamri, Nusr; Joseph, Nejo; Zheng, Helen; Ratnayake, Milidu V. B.; Bissett, Ian P.; Adeyeye, Ademola Adetoyese; Olayinka, Mohammed Taofiq; Alfa, Yakubu; Daniyan, Muhammad; Tolani, Musliu Adetola; Bashir, Muhammed; Musa, Keffi Mubarak; Omon, Henry Ehidiamen; Balogun, Simon Adewale; Anele, Christopher Obinna; Adesunkanmi, Abdul Hafiz O.; Ajekwu, Samuel Chibuzo; Afeikhena, Ehis; Egbuchulem, Ifeanyichukwu Kelvin; Constantine, Ezeme; Olagunju, Naomi; Ikechukwu, Ulasi Bartholomew; Fakoya, Adegbolahan; Ogundoyin, Olakoyode O; Waqar, Usama; Ukrani, Ronika Devi; Mansoor, Maheen; Asghar, Tofique; Jamaluddin, Muhammad; Zahid, Muhammad; Ali, Farjad; Chawla, Tabish; Aamir, Faiqa B.; Tahir, Izza; Farhan, Emaan; Dar, Kamran H.; Saeed, Abdullah B.; Shahbaz, Usama; Alozai, Muhammad Ilyas; Akram, Muhammad U.; Haider, Sohaib; Hai, Arrham; Ahmed, Shaheer; Hussain, Akbar; Durrani, Ahmed M.; Arbi, Fawad M.; Khaliq, Fatima; Abubakr, Muhammad; Khalid, Noor; Khalid, Rizwan; Iqbal, Aqsa; Javed, Arwa; Akhtar, Hamza; Malik, Bilal M.; Khan, Hashim; Butt, Adam U. A.; Malik, Abdur R.; Malick, Daniya S.; Asif, Aiza; Khan, Muhammad Sarfraz; Anwar, Muhammad Idrees; Yaqoob, Sadia; Jarullah, Furqan A.; Umer, Farooq; Jamil, Soomal; Zarin, Mohammad; Khan, Adel; Alam, Mansoor; Shafi, Mahnoor; Fakhar, Samra; Ayaz Ali, Amrat; Dal, Nawaz A.; Shams, Marvi; Laghari, Sundas; Kumar, Yash; ul Haq, Syed Atif; Abdullah, Areeba; Ur Rehman, Sheeraz; Javed, Farhan; Ali, Wasaq; Ahmad, Shahzaib; Joshi, Prabesh; Sarwar, Muhammad Zeeshan; Naqi, Syed Asghar; Daula, Muhammad I. H.; Ijaz, Muhammad Tayyab; Fazal, Talha bin; Javaid, Amna; Rajput, Akram; Masroor, Layiba; Shahab, Tooba; Yaqub, Aimen; Zahid, Sufian M.; Jabbar, Naveed; Javeed, Muhammad Hassan; Karim, Muhammad Qaisar; Jamal, Muhammad Asad; Fazal, Mishaal; Hameed, Fahd Mudassar; Bakhtiar, Mahnoor; Akhtar, Aamena; Khan, Zartaj A.; Rehman, Kiran; Khan, Rehan A.; Farooqui, Fareeha; Aimon, Sibgha; Marjan, Iqra; Al-Saba'a, Yousef K.; Alkahlout, Dana M.; Amer, Fatima M.; Mostafa, Omar; Naim, Deema Sami; Manasra, Mahmoud; Giacaman, Yazan; Zawahra, Aya; Erman, Myyas N.; Abu Reyash, Tamara K.; Shami, Sarah M.; Awwad, Amjad H.; Abu-Arish, Hamdoon; Y. Aljabarein, Osama; Alkomi, Saja; Dweik, Raghad; Atatra, Khalil O.; Yasin, Fawzi Hesham; Saad, Reem J.; Khader, Abdellatif; Hussein, Reema A.; Helles, Ameer A.; Ismail, Ruba S.; Abu Jayyab, Mustafa A.; Hasson, Mohammad; Povo, Ana; Silva, Cláudio; Ginestal, Mariana; Negoi, Ionut; Negoita, Valentina M.; Talpai, Tamás; Pîrvu, Cătălin-Alexandru; Pantea, Stelian; Menzulin, Ruslan; Yanishev, Alexey; Bazaev, Andrey; Chubukova, Natalia; Bagrjancev, Maxim; Ryabkov, Maxim; Abelevich, Alexander; Novikova, Anastastia; Saeed, Reham J. M.; El-Mansoury, Tarek M.; Khogaly, Amer M. A.; Galun, Danijel; Zivanovic, Marko; Serrano-Navidad, Monica; Landaluce-Olavarria, Aitor; Estraviz- Mateos, Begoña; Sainz-Lete, Aitor; Gonzalez-De Miguel, Melania; Zevallos-Quiroz, Julio; Vázquez-Melero, Alba; Sánchez-Rubio, María; Herrero López, Imanol; García López de Goicoechea, David; Camuera González, Maite; Helguera Martínez, Pablo; Balluerca Alba, María; Paunero Vázquez, Patricia; Soeda Seminario, Isami; Mendoza Moreno, Fernando; Matías-García, Belén; Alvarado-Hurtado, Ricardo; Soto-Schütte, Sonia; Alberich Prats, Marta; Madrazo González, Zoilo; López Borao, Jaime; Sueiras Gil, Albert; Martin Santos, Silvia; Gil Barrionuevo, Marta; Rodriguez-Leon, Gerardo; Vallet Fernandez, Josep; Ortiz Rodriguez, Carles; Hevia Falú, Ramiro; Gil Gomez, Vicente; Biel Arrufat, Alex; Alberca Páramo, Ana; Antonaya Rubia, Eva; Rodríguez Cano, María A.; Ruíz Frías, Piedad; Gortázar de las Casas, Sara; Del Castillo Díez, Federico; Guevara Martínez, Jenny; Prieto La Noire, Fernando; Chavarrías Torija, Nuria; Valderrabano Gonzalez, Santiago; Heras Garceau, María; Otero de Pablos, Jaime; Ramos Bonilla, Antonio; Enjuto Martínez, Diego T.; Rodríguez Gómez, Lorena; Diaz Peña, Patricia; Gonzalez Guerreiro, Judit; Cervera Celdrán, Iria; Cagigal Ortega, Elima; García Domínguez, Antonio; Alvarez Cuiñas, Ana; Soldevila-Verdeguer, Carla; Fernández-Vega, Laura; Pagès-Valle, Naila; Coello-González, Alejandro; Colás-Ruiz, Enrique; Alwis, Weerakkodige Mithun Chamindaka; Karunarathne, Rathnayake Mudhiyanselage Dulanee; Bandara, Ginimal Bandaralage Kavinda Deshapriya; Rodrigo, Vitharanage Srimantha Dewsiri; Jayarajah, Umesh; Abdulhamid, Salaheddin M.; Almokdad, Fares Kh.; Senhuri, Alrayah E.; Abdullah, Weaam M.; Abdelwahid, Elharith H.; Idris, Alhaj O.; Galal-Eldin, Sami; Hamid, Hytham K. S.; Mohammed, Alaa M. E.; Ibrahim, Ahmed M.; Ahmed, Samar G.; Osman, Osama S.; El Tahier Abdalla Omer, Mohammad; Toum, Fthelrahman M.; Mohammed Sabir, Fatima; Yaghoub Ali, Abdulhafiz; Abdelmageed, Abdelfatah A.; Khalafalla, Ashraf; Hassan, Luden Saif Aldawla; Mahmoud, Mai D.; Salih, Mugahid A.; Hamdan, Alaa; Mohammad, Mazen; Al Shareeda, Mohamad; Otaky, Mohammad Baraa; Nashed, Ali; Zayat, Hussein; Aloulou, Mohammad; Alsmail, Mohamed H.; Sawas, Fatima; Alghareeb, Rafah; Kudra Danial, Aghyad; Abdullah, Mohammad A.; Krad, Khaled; Masri, Ruqaya; Alannaz, Omar; Halwani, M. Yasser; Ghannam, Mohammad Maen; Kazzaz, Ranim; Tammo, Shergal; Ghazal, Ahmad; Alabad, Madian; Alhasan, Hasan; Alhaj, Ahmad; Aljaber, Ahmad; Jarkas, Bakri T.; Olaisheh, Habib; Hassan, Bassam; Kayali, Ahmad Amir H.; Nasani, Mohannad; Kayali, Hasan F.; Alahmad, Ziad; Arnaout, Khaled; Laila, Aya A. N.; Zalf, Kamal; Hasson, Hussain; Apelian, Shant N.; Makhluf, Hawazen A.; Ibraheem, Fadwa F.; Arnaout, Ahmad Y.; Ibrahim, Hamza; Sharifa, Mohammad; Nastah, Samer; Zayat, Mohammed A.; Tarky Alhashash, Ahmad; Konaizeh, Dani S.; Rostum, Zuhair; Ahmad, Hasan Y.; Aliskander, Fater; Saad, Ahmad; Isik, Arda; Memis, Ufuk; Salih, Saniye; Saracoglu, Kemal Tolga; Hokenek, Ummahan Dalkilinc; Tatar, Ozan Can; Shah, Syed Faraz Ali; Cantürk, Nuh Zafer; Şahin, Enes; Güler, Sertaç Ata; Şimşek, Turgay; Guldogan, Cem E.; Gundogdu, Emre; Ozmen, Mahir M.; Uprak, Tevfik Kıvılcım; Can Şahin, Melike Zeynep; Demirli Atici, Semra; Teker, Kenan; Aktas, Ahmed; Latif, Javed; Mcdermott, Frank; Lederhuber, Hans; Kantola, Venla; Muse, Samantha; Jaralla, Nasir; Roy, Dorina; Mccoubrey, Alison; Botes, Azel; Booth, Alexander; Edgerton, Colston; Al-Eryani, Fatima; Al-Naggar, Hamza; Al-Eryani, Salwa; AL-Wajeeh, Ghadeer; Abotaleb, Khadega; Al-Shehari, Mohammed; Shream, Sarah; Alsayadi, Ramzi; Alemad, Shada; Alshaikh, Bushra Hussein; Al-Dhaheri, Manal Jamal; Al-Hajj Al-Fakih, Wadhah Ahmed; Telha, Khaled A.; Alqatta, Wail M.; Telha, Ghassan K.; Güner , ; Ali, ; Null, Null. - In: JAMA SURGERY. - ISSN 2168-6254. - 158:8(2023). [10.1001/jamasurg.2023.2137]
Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair
Gallo, GaetanoMembro del Collaboration Group
;
2023
Abstract
Importance: Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors. Objective: To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR. Design, setting, and participants: The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR. Exposure: Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia. Main outcomes and measures: The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients. Results: In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72). Conclusions: The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
