General anesthesia may trigger post operative urinary retention in endoscopic nasal surgery
Postoperative urinary retention (POUR) is influenced by many factors, and its reported incidence rate varies widely. However, as reported in the Ear, Nose and Throat Journal, it has been found out that general anesthesia for endoscopic nasal surgery may be a potent trigger for urinary retention in elderly male patients.
Yong Won Lee et al from the Department of Otorhinolaryngology-Head and Neck Surgery, Veterans Health Service Daejeon Hospital, Daejeon, Republic of Korea aimed to investigate the occurrence and risk factors for urinary retention following general anesthesia for endoscopic nasal surgery in male patients aged >60 years.
The authors carried out a retrospective review of medical records, where they identified 253 patients who fulfilled the inclusion criteria. Age, body mass index (BMI), a history of diabetes/hypertension, American Society of Anesthesiologists (ASA) classification, and urologic history were included as patient-related factors.
Urologic history was subdivided into 3 groups according to history of benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and current medication. Various parameters were analyzed, which categorized as perioperative variables for POUR development. These included duration of anesthesia and surgery; amount of fluid administered; rate of fluid administration; intraoperative requirement for fentanyl, ephedrine, and dexamethasone; postoperative pain; and analgesic use.
Preoperatively measured prostate size and uroflowmetry parameters of patients on medication for symptoms were compared according to the incidence of urinary retention.
The study results showed that age (71.4 vs 69.6 years), BMI (23.9 vs 24.9 kg/m2), a history of diabetes/hypertension, ASA classification, and perioperative variables were not significantly different between patients with and without POUR.
Also, only urologic history was identified as a factor affecting the occurrence of POUR (P = .03). The incidence rate among patients without urologic issues was 5.9%, whereas that among patients with BPH/LUTS history was 19.8%.
Among patients taking medication for symptoms, the maximal and average velocity of urine flow were significantly lower in patients with POUR.
As a result, the authors concluded that general anesthesia for endoscopic nasal surgery may be a potent trigger for urinary retention in male patients aged >60 years. The patient's urological history and urinary conditions appear to affect the occurrence of POUR.