1. The Incidence and Risk Factors for
Postoperative Urinary Retention (POUR) in
the Neurosurgical Patients
Azam Basheer MD
Donald Seyfried MD, Senior Staff
Department of Neurosurgery
Henry Ford Hosital
Detroit, MI

2. Introduction
• Definition: inability to empty bladder completely 1
• Sequelae 2-7:
– Can lead to significant pain, anxiety and longer hospital
stays Bladder distention
– Renal failure
• Standard treatment:
– Straight catheterization: could lead to urethral strictures,
trauma, infection and possibly delirium. 7
– Indwelling catheter re insertion if no improvement

3. Incidence
• POUR is reported to occur in 5 to 75% of
all surgical procedures.1,7,9
• Highest in urologic, colorectal and certain
orthopedics procedures
• Multifactorial in nature

4. POUR in Neurosurgery
• Has not been extensively studied.
• Boulis et al. reported a 39.1% incidence in
503 spine patients 10
• Mclain et al reported 23% incidence in 200
lumbar spine patients 11
• Jellish et al, reported 22.9% incidence in
61 lumbar spine patients 12

5. Study Design
• A cohort of 137 neurosurgical patients were
prospectively followed for the development of
POUR between 5/2010 – 6/2011
• Definition: Post void residual (PVR) >250 ml 6
hours after the removal of the indwelling urinary
catheter (IUC)
• For patients with PVR >250 ml on the third
check, IUCs were re-inserted, and kept for 5-7
days.

7. Results
• The overall incidence of clinical POUR
was 39.4%
• Statistical significance (p< 0.05) for high
PVR1 was noted in
– Males
– Patients older than 60 years of age
– Spine surgery

8. PVR1 information by patient
characteristics:
0
100
200
300
400
500
Male Female
Gender (p<0.001)
MeanPVR1(SE)
0
100
200
300
400
500
<60 years 60+ years
Age (p=0.043)
MeanPVR1(SE)
0
100
200
300
400
500
<=200 min >200 min
Surgery Time (p=0.08)
MeanPVR1(SE)
0
100
200
300
400
500
Cranial C/T Lumbar
Surgery location (p=0.012)
MeanPVR1(SE)

9. PVR1 information by patient
characteristics:
0
100
200
300
400
500
Yes No
Diabetes (p=0.10)
MeanPVR1(SE)
0
100
200
300
400
500
Yes No
Beta Blockers (p=0.079)
MeanPVR1(SE)
0
100
200
300
400
500
Yes No
anticholinergic (p=0.634)
MeanPVR1(SE)
0
100
200
300
400
500
<=30 >30
BM I (p=0.265)
MeanPVR1(SE)

10. POUR and Length of Hospital Stay (r=0.176,p=0.04).

11. Results cont.
• Of all patients, 24 (18%) had IUCs re-
inserted postoperatively
• The association of IUC re-insertion with
male gender was significant (28%,
P=0.001).

13. • Table 3: Sensitivity, specificity and positive and negative
predictive values for IUC re-insertion(actual or intended) by
cutpoints of PVR1
PPV

14. Conclusion
• POUR is prevalent among neurosurgical
patients, especially in males, older than 60 years
of age, and those with spinal pathologies.
• It leads to high rates of infection, complication,
cost, and longer hospital stay.
• Studies are under way to find potential points of
intervention that would lead to decreased POUR
incidence.

15. Questions?
Thank you for listening
Credit to:
Dr M. Alsaidi
Dr M. Abdulhak
Dr M. Chedid
Joanne Guiano RN

16. References
1) Gabriele Baldini, M.D.,* Hema Bagry, M.D., F.R.C.A., F.R.C.P.C.,* Armen Aprikian, M.D., F.R.C.S.C.,† Franco
Carli, M.D., M.Phil., F.R.C.A., F.R.C.P.C.‡, Postoperative Urinary Retention Anesthetic and Perioperative
Considerations. Anesthesiology 2009; 110:1139–57
2) Petros JG, Rimm EB, Robillard RJ. Factors influencing urinary tract retention after elective open cholecystectomy.
Surg Gynecol Obstet 1992;174(6): 497–500.
3 ) Williams MP, Wallhagen M, Dowling G. Urinary retention in hospitalized elderly women. J Gerontol Nurs
1993;19(2):7–14.
4 ) Getliffe K. Care of urinary catheters. Nurs Stand. 1996;11(11):47–50.
5.) Schaeffer AJ. Catheter-associated bacteriuria. Urol Clin North Am 1986;13(4): 735–47.
6 ). Smith NK, Albazzaz MK. A prospective study of urinary retention and risk of death after proximal femoral fracture.
Age Ageing 1996;25(2):150–4.
7) Darrah DM MD, Griebling TL, MD, MPHb,c, Silverstein JH, MDd,e, Postoperative Urinary Retention. Anesthesiology
Clin. 27 2009; 465–484
8) Wu AK, M.D.a,*, Auerbach AD, M.D.a, Aaronson DS, M.D.a,b National incidence and outcomes of postoperative
urinary retention in the Surgical Care Improvement Project. Amer Jor of Surgery 2012 Aug;204(2):167-71.
9) Keita H, MD, PhD, Diouf E, MD, Tubach F, MD, Brouwer T, MD, Dahmani S, MD, Mantz J, MD, PhD,
and Desmonts J, MD. Predictive Factors of Early Postoperative Urinary Retention in the Postanesthesia Care
Unit. Anesth Analg. 2005;101:592–6
10) Boulis NM, Mian FS, Rodriguez D, et al. Urinary retention following routine neurosurgical spine procedures. Surg
Neurol 2001;55(1):23–7
11) Mclain RF, M.D., Kalfas I, M.D., Bell GR, M.D., Tetzlaff JE, M.D., Yoon HJ M.D., And Rana M, M.D. Comparison
of spinal and general anesthesia in lumbar laminectomy surgery: a case-controlled analysis of 400 patients. J
Neurosurg Spine 2:17–22, 2005
12) Jellish WS, MD, PhD*, Thalji Z, MD+, Stevenson K, MD*, and Shea J, MDt, A Prospective Randomized Study
Comparing Short- and Intermediate-Term Perioperative Outcome Variables After Spinal or General Anesthesia for
lumbar Disk and Laminectomy Surgery. Anesth Analg 1996;83:559-64