International Journal of Colorectal Disease

, Volume 21, Issue 7, pp 676–682 | Cite as

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

  • Takayuki Toyonaga
  • Makoto Matsushima
  • Nobuhito Sogawa
  • Song Feng Jiang
  • Naomi Matsumura
  • Yasuhiro Shimojima
  • Yoshiaki Tanaka
  • Kazunori Suzuki
  • Junnichi Masuda
  • Masao Tanaka
Original Article

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 

References

  1. 1.
    Petros JG, Bradley TM (1990) Factors influencing postoperative urinary retention in patients undergoing surgery for benign anorectal disease. Am J Surg 159:374–376PubMedCrossRefGoogle Scholar
  2. 2.
    Tammela T, Kontturi M, Lukkarinen O (1986) Postoperative urinary retention. 1. Incidence and predisposing factors. Scand J Urol Nephrol 20:197–201PubMedCrossRefGoogle Scholar
  3. 3.
    Zaheer S, Reilly WT, Pemberton JH, Ilstrup D (1998) Urinary retention after operations for benign anorectal diseases. Dis Colon Rectum 41:696–704PubMedCrossRefGoogle Scholar
  4. 4.
    Gottesman L, Milsom JW, Mazier WP (1989) The use of anxiolytic and parasympathomimetic agents in the treatment of postoperative urinary retention following anorectal surgery. A prospective, randomized, double-blind study. Dis Colon Rectum 32:867–870PubMedCrossRefGoogle Scholar
  5. 5.
    Bowers FJ, Hartmann R, Khanduja KS, Hardy TG Jr, Aguilar PS, Stewart WR (1987) Urecholine prophylaxis for urinary retention in anorectal surgery. Dis Colon Rectum 30:41–42PubMedCrossRefGoogle Scholar
  6. 6.
    Eftaiha MS, Amshel AL, Shonberg IL (1980) Comparison of two agents in prevention of urinary retention after benign anorectal surgery. Dis Colon Rectum 23:470–472PubMedCrossRefGoogle Scholar
  7. 7.
    Cataldo PA, Senagore AJ (1991) Does alpha sympathetic blockade prevent urinary retention following anorectal surgery? Dis Colon Rectum 34:1113–1116PubMedCrossRefGoogle Scholar
  8. 8.
    Bailey HR, Ferguson JA (1976) Prevention of urinary retention by fluid restriction following anorectal operations. Dis Colon Rectum 19:250–252PubMedCrossRefGoogle Scholar
  9. 9.
    Prasad ML, Abcarian H (1978) Urinary retention following operations for benign anorectal diseases. Dis Colon Rectum 21:490–492PubMedCrossRefGoogle Scholar
  10. 10.
    Pompeius R (1966) Detrusor inhibition induced from anal region in man. Acta Chir Scand Suppl 361:1–54PubMedGoogle Scholar
  11. 11.
    Shafik A (1993) Role of warm water bath in inducing micturition in postoperative urinary retention after anorectal operations. Urol Int 50:213–217PubMedCrossRefGoogle Scholar
  12. 12.
    Fleischer M, Marini CP, Statman R, Capella J, Shevde K (1994) Local anesthesia is superior to spinal anesthesia for anorectal surgical procedures. Am Surg 60:812–815PubMedGoogle Scholar
  13. 13.
    Morisaki H, Masuda J, Fukushima K, Iwao Y, Suzuki K, Matsushima M (1996) Wound infiltration with lidocaine prolongs postoperative analgesia after haemorrhoidectomy with spinal anesthesia. Can J Anaesth 43:914–918PubMedCrossRefGoogle Scholar
  14. 14.
    Hoff SD, Bailey HR, Butts DR, Max E, Smith KW, Zamora LF, Skakun GB (1994) Ambulatory surgical hemorrhoidectomy—a solution to postoperative urinary retention? Dis Colon Rectum 37:1242–1244PubMedCrossRefGoogle Scholar
  15. 15.
    Yamana T, Iwadare J (2003) Mucosal plication (Gant–Miwa procedure) with anal encircling for rectal prolapse—a review of the Japanese experience. Dis Colon Rectum 46:S94–S99PubMedGoogle Scholar
  16. 16.
    Barone JB, Cummings KB (1994) Etiology of acute urinary retention following benign anorectal surgery. Am Surg 60:210–211PubMedGoogle Scholar
  17. 17.
    Tammela T (1995) Postoperative urinary retention—why the patient cannot void. Scand J Urol Nephrol 175(Suppl):75–77Google Scholar
  18. 18.
    Tammela T, Arjamaa O (1988) Comparison of long-term and short-term stretch on rat urinary bladder in vitro. Urol Res 16:277–280PubMedCrossRefGoogle Scholar
  19. 19.
    Crystal RF, Hopping RA (1974) Early postoperative complications of anorectal surgery. Dis Colon Rectum 17:336–341PubMedCrossRefGoogle Scholar
  20. 20.
    Stallard S, Prescott S (1988) Postoperative urinary retention in general surgical patients. Br J Surg 75:1141–1143PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Takayuki Toyonaga
    • 1
  • Makoto Matsushima
    • 1
  • Nobuhito Sogawa
    • 1
  • Song Feng Jiang
    • 1
  • Naomi Matsumura
    • 1
  • Yasuhiro Shimojima
    • 1
  • Yoshiaki Tanaka
    • 1
  • Kazunori Suzuki
    • 1
  • Junnichi Masuda
    • 2
  • Masao Tanaka
    • 3
  1. 1.Department of SurgeryMatsushima Hospital Colo-Proctology CenterNishi-ku, YokohamaJapan
  2. 2.Department of AnesthesiologyMatsushima Hospital Colo-Proctology CenterYokohamaJapan
  3. 3.Department of Surgery and OncologyGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan

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