Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair
Stefanie Croghan, Helen Mohan, Kieran J. Breen, Ruth McGovern, Kathleen Bennett, Michael R. Boland, Muhammed Elhadi, Jessie A. Elliott, Anna Fullard, Peter E. Lonergan, Frank McDermott, Asif Mehraj, Francesco Pata, David M. Quinlan, D. C. Winter, Jarlath Bolger, Christina Fleming, Pablo Farinelli, María Alday, Nicolás Avellaneda, María Goya, Gastón Clemente, Juan Cruz Lopez, David Proud, Natassia Shulman, Dora Huang, Wael Jamel, Sonia Gill, Thomas Arthur, Daisy Swindon, Amy Frank, Roy Teng, Irene Chua, Nicole Chong, Amy Hannigan, Madhu Srinivasan, Aysha Al Bastaki, Sharifa Ahmad, Isam M Juma, Wah Yang, Huaxi Wang, Shuwen Jiang, Eddy P Lincango Naranjo, Carla M Dominguez, Luis F Huilca, José Ricardo Negrete Ocampo, Ahmed Nafea, Selmy Awad, Merihan A. Elbadawy, Aya Abdulmonem, Mahmoud Shaaban Abdelgalil, Salma Tarek Helmy, Sally Ahmed Abd El-razik, Laila Raafat Mabrouk, Ahmed Hassan A. Rady, Ahmed Shaheen, Moataz Ewedah, Marina Farag, Yousef Tanas, Yomna E. Dean, Maha Ghanem, Amir F. Asla, Ahmed M. Ghatwary, Menan A. Elsadek, Aalaa Saad, Ramy A. Hassan, Mohamed Omar Herdan, Mahmoud A. Nassar, Sherif Alaa, Areej A. Khamis, Hadeer M.S. Youssef, Mohamed A. El Sherpiny, Eslam Shehata, Sandy A. Taha, Ahmed A.A.A Zahran, Mohamed Al-Nagdy, Somaya Z.E Sayed Hafez, Shymaa M. Abo Ghanima, Sherif Farahat, Fatma M. Morgan, Shaimaa Mahfouz, Hossam Elfeki, Hosam Elghadban, Mostafa Shalaby, Mohamed Shetiwy, Mohamed Mostafa, Ahmad Sakr, Ahmed S. Elsayed, Kareem Sadek, Maher Eldeghedi, Mohamed Nader, Reem Elsaadany, Yousef Hesham, Omar Attiya, Abdelrahman Shaaban, Yara Sakr, Mohammed Alharazin, Mohammed A. Omar, Marwa N. Alansary, Mahmoud Ahmed Ebada
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.