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

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.