Systematic review of interventions for the prevention and treatment of postoperative urinary retention

Joni Jackson, Philippa Davies, Nick Leggett, Manjula Nugawela Pathirannehelage, Lauren Scott, Verity Leach, Alison Richards, Anthony Blacker, Paul Abrams, Jitin Sharma, Jenny Donovan, Penny Whiting

Research output: Contribution to journalArticle (Academic Journal)peer-review

7 Citations (Scopus)
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Abstract

Background:Postoperative urinary retention (PO-UR) is an acute and painful inability to void aftersurgery that can lead to complications and delayed hospital discharge. Standard treatment with a urinarycatheter is associated with a risk of infection and can be distressing, undignified and uncomfortable. Thissystematic review aimed to identify effective interventions for the prevention and treatment of PO-URthat might be alternatives to urinary catheterization.Methods:Electronic databases were searched from inception to September 2017. Randomized trialsof interventions for the prevention or treatment of PO-UR were eligible for inclusion. Studies wereassessed for risk of bias using the Cochrane (2.0) tool. Two reviewers were involved at all review stages.Where possible, data were pooled using random-effects meta-analysis. The overall quality of the bodyof evidence was rated using the GRADE approach.Results:Some 48 studies involving 5644 participants were included. Most interventions were pharma-cological strategies to prevent PO-UR. Based on GRADE, there was high-certainty evidence to supportreplacing morphine in a regional anaesthetic regimen, using alpha-blockers (number needed to treatto prevent one case of PO-UR (NNT) 5, 95 per cent c.i. 5 to 7), the antispasmodic drug drotaverine(NNT 9, 7 to 30) and early postoperative mobilization (NNT 5, 4 to 8) for prevention, and employ-ing hot packs or gauze soaked in warm water for treatment (NNT 2, 2 to 4). Very few studies reportedon secondary outcomes of pain, incidence of urinary tract infection or duration of hospital stay.Conclusion:Promising interventions exist for PO-UR, but they need to be evaluated in randomized trialsinvestigating comparative clinical and cost effectiveness, and acceptability to patients.
Original languageEnglish
Pages (from-to)11-23
Number of pages13
JournalBJS Open
Volume3
Issue number1
Early online date19 Nov 2018
DOIs
Publication statusPublished - Feb 2019

Structured keywords

  • Centre for Surgical Research

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