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. 2023 Aug 1;158(8):865-873.
doi: 10.1001/jamasurg.2023.2137.

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair: The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) Study

Stefanie M Croghan  1 , Helen M Mohan  1   2 , Kieran J Breen  3 , Ruth McGovern  4 , Kathleen E Bennett  5 , Michael R Boland  6 , Muhammed Elhadi  7 , Jessie A Elliott  8 , Anna C Fullard  9 , Peter E Lonergan  10   11 , Frank McDermott  12 , Asif Mehraj  13 , Francesco Pata  14   15 , David M Quinlan  3 , Des C Winter  16 , Jarlath C Bolger  17 , Christina A Fleming  9 ; RETAINER I Study Group of the Irish Surgical Research Collaborative
Collaborators, Affiliations

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair: The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) Study

Stefanie M Croghan et al. JAMA Surg. .

Erratum in

Abstract

Importance: Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors.

Objective: To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR.

Design, setting, and participants: The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR.

Exposure: Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia.

Main outcomes and measures: The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients.

Results: In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72).

Conclusions: The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Croghan reported receiving nonfinancial support from the Royal College of Surgeons in Ireland during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flow Diagram of Patients Enrolled in the Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) Study
Shown are numbers included in the final analysis and their representation of country income and sex categories.
Figure 2.
Figure 2.. Receiver Operating Characteristic Curve of the Multivariable Analysis of Risk Factors for Postoperative Urinary Retention (POUR) in Male Patients
Area under the receiver operating characteristic curve, 0.7587.
See this image and copyright information in PMC

Comment in

References

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