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OBJECTIVE:
To define the incidence of post-operative urinary retention in males greater than 50 years of age following carotid endarterectomy (CEA) while undergoing general anesthesia.
METHODS:
A pilot study was conducted to determine the true incidence of postoperative urinary retention among the male carotid endarterectomy population over the age of 50 undergoing general anesthesia. Exclusion criteria included females, males < 50 years of age, use of regional anesthesia, current prostate medication regimen, previous cystectomy, urinary conduit surgery or prostatectomy, and history of prostate cancer. After obtaining IRB approval, a pilot study was conducted. A questionnaire designed by the AUA (American Urologic Association) was used to determine the severity of preoperative urinary retention. This permitted patient stratification into mild, moderate, and severe risk. Post-operatively, an order was placed to catheterize those patients experiencing symptoms of urinary retention or the inability to void within eight hours of surgery. Laboratory values and total urine output were monitored post-operatively.
RESULTS:
Twenty-two percent of the cohort (n=41) had urinary retention post operatively requiring either clean intermittent catheterization, Foley placement, or discharge with a leg bag. Pre-operative risk stratification of urinary retention predicted the probability of retention within each category. The 41 patients included for analysis were identified as, no risk, 50% (n=20), mild risk, 13% (n=23), moderate risk, 27% (n=15), severe risk, 100% (n=1).
CONCLUSION:
The incidence of postoperative urinary retention in males greater than 50 years of age following carotid endarterectomy while undergoing general anesthesia is very likely. This phenomenon has been described in the literature and has been associated with longer length of hospital stay and increased morbidity, therefore, we believe there is a need for further research. In future studies we would like to consider development of a pre-operative protocol for management of those patients at moderate or high risk for post-operative urinary retention after CEA.