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Postoperative Urinary Retention is an Independent Predictor of Short-Term and Long-Term Future Bladder Outlet Procedure in Men

Robert H. Blackwell, Srikanth Vedachalam, Arpeet S. Shah, Anai N. Kothari, Paul C. Kuo, Gopal N. Gupta, Thomas M.T. Turk
DOI: http://dx.doi.org/10.1016/j.juro.2017.06.023
Purpose
Postoperative urinary retention is a common complication across surgical specialties. To our knowledge no literature to date has examined postoperative urinary retention as a predictor of long-term receipt of surgery for bladder outlet obstruction.

Materials and Methods
We retrospectively reviewed the records of inpatients who underwent nonurological surgery in California between 2008 and 2010. Postoperative urinary retention during the index admission was identified, as was receipt of a bladder outlet procedure (transurethral prostate resection, prostate photoselective vaporization or suprapubic prostatectomy) at a subsequent encounter. Patients were matched using propensity scoring of demographics, comorbidities and surgery type. Adjusted Kaplan-Meier analysis was performed to determine the cumulative incidence of subsequent bladder outlet procedures by patient group, including group 1—age 60 years or greater and postoperative urinary retention, group 2—age 60 years or greater and no postoperative urinary retention, group 3—age less than 60 years and postoperative urinary retention, and group 4—age less than 60 years and no postoperative urinary retention.

Results
Of 769,141 eligible male patients postoperative urinary retention developed in 8,051 (1.1%). Following hospital discharge 1,855 patients (0.24%) underwent a bladder outlet procedure. Those treated with a bladder outlet procedure were significantly more likely to have experienced postoperative urinary retention during the index admission (6.3% vs 1.0%, p <0.001). On matched analysis the bladder outlet procedure rate at 3 years was 7.1%, 2.2%, 0.8% and 0.0% in groups 1, 2, 3 and 4, respectively.

Conclusions
In men 60 years old or older postoperative urinary retention identified those with an increased incidence of bladder outlet procedures within 3 years. Men younger than 60 years had a low rate of subsequent bladder outlet procedures regardless of a postoperative urinary retention diagnosis.

Key Words:
urinary bladder, urinary retention, postoperative complications, urinary bladder neck obstruction, age groups

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