Our Summary

This research paper is examining the possible causes of postoperative urinary retention (POUR), which is when a person has difficulty emptying their bladder after surgery. The scientists were particularly interested in whether spinal anesthesia, which is often used during surgery, was one of these causes.

To test this, they looked back at a database of surgeries performed in 2014 where the patient was suffering from pelvic organ prolapse (POP) - a condition where organs in the pelvis, such as the bladder or uterus, sag or move from their normal position. All of these surgeries were done on an outpatient basis and involved repairing the vagina, and they were interested in cases where the patient had to be sent home with a catheter because they couldn’t empty their bladder.

They found that nearly half of the surgeries resulted in POUR, but interestingly, whether the patient received spinal or general anesthesia made no difference. Instead, the risk factors for POUR were being younger than 55, having diabetes, and having a severe form of POP where the bladder is sagging into the vagina. They conclude that while POUR is a common problem after these types of surgeries, it’s not caused by the type of anesthesia used.

FAQs

  1. What is postoperative urinary retention (POUR) and what might cause it?
  2. Does the type of anesthesia used during surgery, specifically spinal anesthesia, increase the risk for postoperative urinary retention?
  3. What factors increase the risk of experiencing postoperative urinary retention after a surgery for pelvic organ prolapse?

Doctor’s Tip

A helpful tip a doctor might tell a patient about spinal surgery is to follow postoperative instructions carefully, including any recommended exercises or physical therapy, to help promote healing and prevent complications such as urinary retention. It’s also important to stay hydrated and try to empty your bladder regularly to prevent any issues with urination. Additionally, discussing any concerns or symptoms with your healthcare provider can help address any potential issues early on.

Suitable For

Patients who are typically recommended spinal surgery include those with severe back pain, herniated discs, spinal stenosis, scoliosis, spinal fractures, and other spinal conditions that have not responded to conservative treatments such as physical therapy or medication. Additionally, patients with spinal tumors or spinal cord injuries may also be recommended for spinal surgery. It is important for patients to undergo a thorough evaluation by a spine specialist to determine if surgery is the best treatment option for their specific condition.

Timeline

Before spinal surgery:

  1. Patient consults with a surgeon to discuss the need for spinal surgery and potential treatment options.
  2. Patient undergoes preoperative testing and evaluations to assess their overall health and determine if they are a suitable candidate for surgery.
  3. Patient receives instructions on preoperative preparations such as fasting, medication adjustments, and lifestyle modifications.
  4. Patient undergoes spinal surgery under either general or spinal anesthesia, depending on the specific procedure and patient’s health status.

After spinal surgery:

  1. Patient is closely monitored in the recovery room for any immediate postoperative complications.
  2. Patient is transferred to a hospital room or postoperative care unit for ongoing monitoring and pain management.
  3. Patient may experience temporary side effects such as nausea, fatigue, and pain at the surgical site.
  4. Depending on the type of surgery, patient may need to stay in the hospital for a few days for further observation and rehabilitation.
  5. Patient receives instructions on postoperative care, including wound care, medication management, and physical therapy exercises.
  6. Patient follows up with their surgeon for postoperative appointments to monitor their recovery progress and address any concerns or complications.

What to Ask Your Doctor

Some questions a patient should ask their doctor about spinal surgery include:

  1. What are the potential risks and complications associated with spinal surgery?
  2. How long is the recovery process expected to be after spinal surgery?
  3. What are the expected outcomes of the surgery in terms of pain relief or improved mobility?
  4. Will physical therapy or rehabilitation be necessary after the surgery?
  5. Are there any alternative treatments or less invasive procedures that could be considered before opting for spinal surgery?
  6. How many times has the surgeon performed this specific type of spinal surgery, and what is their success rate?
  7. What is the expected timeline for returning to normal activities or work after spinal surgery?
  8. What are the long-term implications or potential complications of spinal surgery?
  9. Will there be any restrictions on physical activity or movement after the surgery?
  10. What steps can be taken to minimize the risk of postoperative complications, such as POUR, after spinal surgery?

Reference

Authors: Alas A, Hidalgo R, Espaillat L, Devakumar H, Davila GW, Hurtado E. Journal: Int Urogynecol J. 2019 Aug;30(8):1283-1289. doi: 10.1007/s00192-019-03893-1. Epub 2019 Feb 27. PMID: 30810782