腹股溝疝氣修補術後發生急性尿滯留的危險因子
謝尚儒、陳國鋅1、鍾旭東2、吳維哲2、俞錫全2
1亞東紀念醫院 外科部 一般外科；2亞東紀念醫院 外科部 泌尿科
Risk factors for acute urine retention after inguinal herniorrhaphy
Shang-Ju Hsieh, Kuo-Hsin Chen1, Shiu- Dong Chung2, Wei-Che Wu2, Shyi-Chun Yii2
Division of General surgery1, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Division of Urology2 Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
Purpose: Acute urine retention (AUR) is a common complication postoperatively in various surgery. The incidence of AUR after inguinal herniorrhaphy was previously reported to range from 0.37% to 22.2%. Our study sought to determine the incidence of AUR and identify the risk factors for AUR following either open or laparoscopic herniorrhaphy.
Materials and Methods: 426 male patients from a single center including baseline characteristics, comorbidities, operative information were collected and reviewed retrospectively from the period of March 2018 to February 2019. Statistic analysis was conducted on patient’s characteristics, medical histories, anesthesia notes and postoperative notes to identify any risk factor that may develop AUR. Variables tested against the dependent variable (AUR) were selected using chi-square tests for categorical variables and t tests for continuous variables. Multivariate logistic regression analysis was performed to examine the independent risk factors for AUR following inguinal herniorrhaphy.
Results: A total of 426 patients were initially identified. 15 patients were excluded due to initial presentation of unstable vital signs ( n=9 ), acceptance of local anesthesia (n=3), and combined with other urolithiasis surgery ( n=3 ). Among 411 male patients who underwent inguinal repair (laparoscopic: 279; open: 132), 31 patients experienced AUR after the operation, which determine an incidence of 7.5%. Old age, acceptance of open herniorrhaphy, spinal anesthesia, history of diabetes mellitus (DM) and benign prostate hyperplasia (BPH) and usage of postoperative analgesics injection showed statistically significance (P < 0.05) on univariate analyses. On multivariable analysis, only DM (OR = 2.64, 95% CI = 1.02-6.81, P = 0.045), BPH history (OR = 2.37, 95% CI = 1.02-5.48, P = 0.044), acceptance of spinal anesthesia (OR = 2.31, 95% CI = 1.05-5.09, P = 0.038), and postoperative analgesics injection use (OR = 3.66, 95% CI = 1.66-8.11, P = 0.001) were identified as independent risk factors of postoperative urine retention.
Conclusion: In our study, history of DM and BPH, acceptance of spinal anesthesia and postoperative analgesics injection use were four independent risk factors for AUR following inguinal herniorrhaphy. Therefore, additional medical care may be needed in these populations for prevention of AUR.