Original Article

International Journal of Colorectal Disease

, Volume 21, Issue 7, pp 676-682

Postoperative urinary retention after surgery for benign anorectal disease: potential risk factors and strategy for prevention

  • Takayuki ToyonagaAffiliated withDepartment of Surgery, Matsushima Hospital Colo-Proctology Center Email author 
  • , Makoto MatsushimaAffiliated withDepartment of Surgery, Matsushima Hospital Colo-Proctology Center
  • , Nobuhito SogawaAffiliated withDepartment of Surgery, Matsushima Hospital Colo-Proctology Center
  • , Song Feng JiangAffiliated withDepartment of Surgery, Matsushima Hospital Colo-Proctology Center
  • , Naomi MatsumuraAffiliated withDepartment of Surgery, Matsushima Hospital Colo-Proctology Center
  • , Yasuhiro ShimojimaAffiliated withDepartment of Surgery, Matsushima Hospital Colo-Proctology Center
  • , Yoshiaki TanakaAffiliated withDepartment of Surgery, Matsushima Hospital Colo-Proctology Center
  • , Kazunori SuzukiAffiliated withDepartment of Surgery, Matsushima Hospital Colo-Proctology Center
  • , Junnichi MasudaAffiliated withDepartment of Anesthesiology, Matsushima Hospital Colo-Proctology Center
    • , Masao TanakaAffiliated withDepartment of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University

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Abstract

Purpose

This study was undertaken to determine the incidence of and risk factors for urinary retention after surgery for benign anorectal disease.

Methods

We reviewed 2,011 consecutive surgeries performed under spinal anesthesia for benign anorectal disease from January through June 2003 to identify potential risk factors for postoperative urinary retention. In addition, we prospectively investigated the preventive effect of perioperative fluid restriction and pain control by prophylactic analgesics on postoperative urinary retention.

Results

The number of procedures and the urinary retention rates were as follows: hemorrhoidectomy, 1,243, 21.9%; fistulectomy, 349, 6.3%; incision/drainage, 177, 2.3%; and sliding skin graft/lateral subcutaneous internal sphincterotomy, 64, 17.2%. The overall urinary retention rate was 16.7%. With hemorrhoidectomy, female sex, presence of preoperative urinary symptoms, diabetes mellitus, need for postoperative analgesics, and more than three hemorrhoids resected were independent risk factors for urinary retention as assessed by multivariate analysis. With fistulectomy, female sex, diabetes mellitus, and intravenous fluids >1,000 ml were independent risk factors for urinary retention. Perioperative fluid restriction, including limiting the administration of intravenous fluids, significantly decreased the incidence of urinary retention (7.9 vs 16.7%, P<0.0001). Furthermore, prophylactic analgesic treatment significantly decreased the incidence of urinary retention (7.9 vs 25.6%, P=0.0005).

Conclusions

Urinary retention is a common complication after anorectal surgery. It is linked to several risk factors, including increased intravenous fluids and postoperative pain. Perioperative fluid restriction and adequate pain relief appear to be effective in preventing urinary retention in a significant number of patients after anorectal surgery.

Keywords

Urinary retention Anorectal surgery Anal fistula Hemorrhoid