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Prophylactic alpha-blockade for prevention of post-operative urinary retention after inguinal hernia repair: a systematic review and meta-analysis

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Abstract

Background

The rate of post-operative urinary retention (POUR) in inguinal hernia repairs (IHR) is estimated to be approximately 5.9% to 38% worldwide. Currently, there are minimal studies on the prophylaxis of POUR after IHR. Pre-operative administration of alpha-blockers such as (but not limited to) Tamsulosin, Prazosin and Alfuzosin has shown promising results in the prevention of POUR in patients undergoing IHR. This study aims to determine the effectiveness of prophylactic alpha-blockade in the prevention of POUR after IHR.

Methods

This study reports the findings of a systematic review and meta-analysis. Randomised controlled trials (RCTs) using prophylactic alpha-blockade for the prevention of POUR after open and/or laparoscopic IHR in patients aged more than 18 years in all sex groups were included. Multiple databases were searched from inception to October 2021 using the PRISMA flow diagram. Data were extracted and analysed to include eligibility criteria, comparator, intervention, study and participant characteristics. Studies excluded were non-RCT studies and patients with known urinary tract disorders such as benign prostate hypertrophy, urinary incontinence and cancer of the bladder or prostate. Subgroup analyses were also conducted. All effect measures of each data were odds ratio with 95% confidence interval. All studies were pooled using the dichotomous random effects Mantel–Haenszel statistical mode and I2 was used to assess heterogeneity. Publication bias was detected using the Cochrane risk-of-bias tool for randomised trials (RoB-2) involving two independent reviewers.

Results

A total of eight RCTs were identified which provided adequate numeric data for incorporation into the meta-analysis. Overall, administration of pre-operative alpha-blocker prior to IHR did not prevent POUR (95% CI 1.20 (0.96–1.49), I2: 34%). Subgroup analysis comparing pre-operative use of prophylactic alpha-blocker in open versus laparoscopic IHR has shown statistically significant reduction of POUR prevention in the laparoscopic group (95% CI 0.66 (0.47–0.92)), I2: 43%). The older age group benefited from pre-operative alpha-blocker use with reduced incidence of POUR post-IHR (95% CI 0.14 (0.08, 0.23), I2: 0%)). Gender did not affect the difference of incidence of POUR post-IHR despite pre-operative alpha-blockers (95% CI 0.62 (0.27, 1.44)), I2: 53%)).

Conclusion

Overall, this meta-analysis has shown that administration of prophylactic alpha-blockers did not prevent POUR. However, there was statistically significant reduction of POUR in patients undergoing laparoscopic IHR as compared to open, as well as in older patients (age more than 60 years) after administration of pre-operative alpha-blocker. Hence, the use of pre-operative alpha-blocker especially in older patients should be considered and more RCTs should be undertaken.

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Availability of data and materials

The data that support the findings of this study are available from the corresponding author, A. Drahman, upon reasonable request.

References

  1. Matthews RD, Neumayer L (2008) Inguinal hernia in the 21st century: an evidence-based review. Curr Probl Surg 45(4):261–312. https://doi.org/10.1067/j.cpsurg.2008.01.002

    Article  PubMed  Google Scholar 

  2. Bittner R, Arregui ME, Bisgaard T et al (2011) Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 25(9):2773–2843. https://doi.org/10.1007/s00464-011-1799-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Baldini G, Bagry H, Aprikian A et al (2009) Postoperative urinary retention: anaesthetic and perioperative considerations. Anesthesiology 110(5):1139–1157. https://doi.org/10.1097/ALN.0b013e31819f7aea

    Article  PubMed  Google Scholar 

  4. Zayadin Y, D’John J, Yaldo B et al (2019) Urinary retention post open vs laparoscopic vs robotic inguinal hernia repair: a comparative retrospective review. J Am Coll Surg 229(4):e129

    Article  Google Scholar 

  5. Blair AB, Dwarakanath A, Mehta A et al (2017) Postoperative urinary retention after inguinal hernia repair: a single institution experience. Hernia 21(6):895–900. https://doi.org/10.1007/s10029-017-1661-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Sivasankaran MV, Pham T, Divino CM (2014) Incidence and risk factors for urinary retention following laparoscopic inguinal hernia repair. Am J Surg 207(2):288–292. https://doi.org/10.1016/j.amjsurg.2013.06.005

    Article  PubMed  Google Scholar 

  7. Tse W, Johnson R, Savas J et al (2019) What is the cost of that ER visit? An analysis of inguinal hernia repairs and non-scheduled follow-up. J Am Coll Surg 229(4):e130. https://doi.org/10.1111/ans.18016

    Article  Google Scholar 

  8. Winslow ER, Quasebarth M, Brunt LM (2004) Perioperative outcomes and complications of open vs laparoscopic extraperitoneal inguinal hernia repair in a mature surgical practice. Surg Endosc 18(2):221–227. https://doi.org/10.1007/s00464-003-8934-y

    Article  CAS  PubMed  Google Scholar 

  9. Hudak KE, Frelich MJ, Rettenmaier CR et al (2015) Surgery duration predicts urinary retention after inguinal herniorrhaphy: a single institution review. Surg Endosc 29(11):3246–3250. https://doi.org/10.1007/s00464-015-4068-2

    Article  PubMed  PubMed Central  Google Scholar 

  10. Petros JG, Bradley TM (1990) Factors influencing postoperative urinary retention in patients undergoing surgery for benign anorectal disease. Am J Surg 59(4):374–376. https://doi.org/10.1016/s0002-9610(05)81274-7

    Article  Google Scholar 

  11. Kozol RA, Mason K, Mcgee K (1992) Post-herniorrhaphy urinary retention: a randomised prospective study. J Surg Res 52(2):111–112. https://doi.org/10.1016/0022-4804(92)90288-b

    Article  CAS  PubMed  Google Scholar 

  12. Stallard S, Prescott S (1988) Postoperative urinary retention in males: a randomised controlled trial. J Surg Res 52(2):111–112. https://doi.org/10.1002/bjs.1800751128

    Article  Google Scholar 

  13. Durant PA, Yaksh TL (1988) Drug effects on urinary bladder tone during spinal morphine-induced inhibition of the micturition reflex in unanesthetized rats. Anaesthesiology 68(3):325–334. https://doi.org/10.1097/00000542-198803000-00002

    Article  CAS  Google Scholar 

  14. Kebapci N, Yenilmez A, Efe B et al (2007) Bladder dysfunction in type 2 diabetic patients. Neurourol Urodyn 26(6):814–819. https://doi.org/10.1002/nau.20422

    Article  PubMed  Google Scholar 

  15. Petros JG, Rimm EB, Robillard RJ et al (1991) Factors influencing postoperative urinary retention in patients undergoing elective inguinal herniorrhaphy. Am J Surg 161(4):431–433. https://doi.org/10.1016/0002-9610(91)91105-r

    Article  CAS  PubMed  Google Scholar 

  16. Cramer SO, Malangoni MA, Schulet WJ et al (1983) Inguinal hernia repair before and after prostatic resection. Surgery 94:627–630

    CAS  PubMed  Google Scholar 

  17. Abramson JH, Gofin J, Makler A et al (1978) The epidemiology of inguinal hernia: a survey in western Jerusalem. J Epidemiol Community Health 32:59–67. https://doi.org/10.1136/jech.32.1.59

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Craighead CC, Cotlar AM, Moore K (1969) Associated disorders with acute incarcerated groin hernia. Ann Surg 159:987–990. https://doi.org/10.1097/00000658-196406000-00015

    Article  Google Scholar 

  19. Martin JD, Stone HH (1962) Recurrent inguinal hernia. Ann Surg 156:713–718. https://doi.org/10.1097/00000658-196211000-00002

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. McDonald DF, Huggins C (1949) Simultaneous prostatectomy and inguinal herniorrhaphy. Surg Gynecol Obstet 89:621–622

    CAS  PubMed  Google Scholar 

  21. Gosling JA, Dixon JS, Lendon RG (1977) The autonomic innervation of the human male and female bladder neck and proximal urethra. J Urol 118:302–305. https://doi.org/10.1016/s0022-5347(17)57981-1

    Article  CAS  PubMed  Google Scholar 

  22. Caine M, Pfau A, Perlberg S (1976) The use of alpha-adrenergic blockers in benign prostatic obstruction. Br J Urol 48:255–263. https://doi.org/10.1111/j.1464-410x.1976.tb03013.x

    Article  CAS  PubMed  Google Scholar 

  23. Smith DR (1960) Estimation of the amount of residual urine by means of the phenolsulfonphthalein test. J Urol 83:188–191. https://doi.org/10.1016/s0022-5347(17)65684-2

    Article  CAS  PubMed  Google Scholar 

  24. Gosling JA (1979) The structure of the bladder and urethra in relation to function. Urol Clin North Am 6:31–38

    Article  CAS  PubMed  Google Scholar 

  25. Finkbeiner AE, Bissada NK (1980) Drug therapy for lower urinary tract dysfunction. Urol Clin North Am 7:3–5

    Article  CAS  PubMed  Google Scholar 

  26. Nordling J (1978) Alpha blockers and urethral pressure in neurological patients. Urol Int 33:304–306. https://doi.org/10.1159/000280215

    Article  CAS  PubMed  Google Scholar 

  27. Evron S, Magura F, Sadovsky E (1984) Prevention of urinary retention with phenoxybenzamine during epidural morphine anaesthesia. Br Med J 288:190–192

    Article  CAS  Google Scholar 

  28. Leventhal A, Pfau A (1978) Pharmacologic management of post-operative over distention of the bladder. Surg Gynecol Obstet 146:347–348

    CAS  PubMed  Google Scholar 

  29. Toyonaga T, Matsushima M, Sogawa N, Jiang SF, Matsumura N, Shimojima Y et al (2006) Postoperative urinary retention after surgery for benign anorectal disease: potential risk factors and strategy for prevention. Int J Colorectal Dis 21:676–682. https://doi.org/10.1007/s00384-005-0077-2

    Article  PubMed  Google Scholar 

  30. Lee SJ, Kim YT, Lee TY, Woo YN (2007) Analysis of risk factors for acute urinary retention after non-urogenital surgery. Korean J Urol 48:1277–1284. https://doi.org/10.4111/kju.2007.48.12.1277

    Article  Google Scholar 

  31. Lee KS, Lim KH, Kim SJ, Choi HJ, Noh DH, Lee HW et al (2011) Predictors of successful trial without catheter for postoperative urinary retention following non-urological surgery. Int Neurourol J 15:158–165. https://doi.org/10.5213/inj.2011.15.3.158

    Article  PubMed  PubMed Central  Google Scholar 

  32. Zaheer S, Reilly WT, Pemberton JH, Ilstrup D (1998) Urinary retention after operations for benign anorectal diseases. Dis Colon Rectum 41:696–704. https://doi.org/10.1007/BF02236255

    Article  CAS  PubMed  Google Scholar 

  33. Lepor H (2005) Managing and preventing acute urinary retention. Rev Urol 7(Suppl 8):S26–S33

    PubMed  PubMed Central  Google Scholar 

  34. Bailey HR, Ferguson JA (1976) Prevention of urinary retention by fluid restriction following anorectal operations. Dis Colon Rectum 19:250–252. https://doi.org/10.1007/BF02590913

    Article  CAS  PubMed  Google Scholar 

  35. Bross S, Schumacher S, Scheepe JR, Zendler S, Braun PM, Alken P et al (1999) Effects of acute urinary bladder overdistension on bladder response during sacral neurostimulation. Eur Urol 36:354–359. https://doi.org/10.1159/000019999

    Article  CAS  PubMed  Google Scholar 

  36. Mulroy MF (2002) Hernia surgery, anesthetic technique, and urinary retention-apples, oranges, and kumquats? Reg Anesth Pain Med 27:587–589. https://doi.org/10.1053/rapm.2002.37326

    Article  PubMed  Google Scholar 

  37. Wein AJ, Dmochowski RR (2012) Neuromuscular dysfunction of the lower urinary tract. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA (eds) Campbell-Walsh urology, 10th edn. Saunders, Philadelphia, p 1940

    Google Scholar 

  38. Buckley BS, Lapitan MC (2010) Drugs for treatment of urinary retention after surgery in adults. Cochrane Database Syst Rev 10:CD008023. https://doi.org/10.1002/14651858.CD008023.pub2

    Article  Google Scholar 

  39. Finkbeiner AE (1985) Is bethanechol chloride clinically effective in promoting bladder emptying? A literature review. J Urol 134:443–449. https://doi.org/10.1016/s0022-5347(17)47234-x

    Article  CAS  PubMed  Google Scholar 

  40. Patel R, Fiske J, Lepor H (2003) Tamsulosin reduces the incidence of acute urinary retention following early removal of the urinary catheter after radical retropubic prostatectomy. Urology 62:287–291. https://doi.org/10.1016/s0090-4295(03)00333-9

    Article  PubMed  Google Scholar 

  41. Djavan B, Shariat S, Fakhari M, Ghawidel K, Seitz C, Partin AW et al (1999) Neoadjuvant and adjuvant alpha-blockade improves early results of high-energy transurethral microwave thermotherapy for lower urinary tract symptoms of benign prostatic hyperplasia: a randomized, prospective clinical trial. Urology 53:251–259. https://doi.org/10.1016/s0090-4295(98)00538-x

    Article  CAS  PubMed  Google Scholar 

  42. Baldini G, Bagry H, Aprikian A, Carli F (2009) Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology 110:1139–1157. https://doi.org/10.1097/ALN.0b013e31819f7aea

    Article  PubMed  Google Scholar 

  43. Petros JG, Rimm EB, Robillard RJ, Argy O (1991) Factors influencing postoperative urinary retention in patients undergoing elective inguinal herniorrhaphy. Am J Surg 161:431–433. https://doi.org/10.1016/0002-9610(91)91105-r

    Article  CAS  PubMed  Google Scholar 

  44. Chen J, Matzkin H, Lazauskas T, Lelcuk S, Braf Z (1993) Posthernioplasty urinary retention: a noninvasive work-up for prediction. Urol Int 51:243–245. https://doi.org/10.1159/000282555

    Article  CAS  PubMed  Google Scholar 

  45. Barone JG, Cummings KB (1994) Etiology of acute urinary retention following benign anorectal surgery. Am Surg 60:210–211

    CAS  PubMed  Google Scholar 

  46. Darrah DM, Griebling TL, Silverstein JH (2009) Postoperative urinary retention. Anesthesiol Clin 27:465–484. https://doi.org/10.1016/j.anclin.2009.07.010

    Article  PubMed  Google Scholar 

  47. Savona-Ventura C, Grech ES, Saliba I (1991) Pharmacological measures to prevent post-operative urinary retention; a prospective randomized study. Eur J Obstet Gynecol Reprod Biol 41:225–229

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

I would like to express my greatest appreciation to Dr Soon Lau and Dr Michael Crawford for their tireless support and advice in the initiation, development and conclusion of this study. I would also like to extend my gratitude to the authors of the studies included in this review. It has been an incredible experience completing this review and thank you once again to all who made this possible without major difficulties.

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The author(s) received no financial support for the research, authorship, and/or publication of this article.

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  1. Department of Surgery, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia

    A. Drahman, S. L. Ngee-Soon & M. Crawford

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  1. A. Drahman
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Correspondence to A. Drahman.

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Drahman, A., Ngee-Soon, S.L. & Crawford, M. Prophylactic alpha-blockade for prevention of post-operative urinary retention after inguinal hernia repair: a systematic review and meta-analysis. Hernia 27, 1351–1361 (2023). https://doi.org/10.1007/s10029-023-02764-5

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