Post-Operative Urinary Retention after EVAR: Are Graft Component Sizes Predictive?
Wayne Tse, MD, Luke Wolfe, MS, Michael Amendola, MD.
VA Medical Center/VCU Health System, Richmond, VA, USA.
BACKGROUND:
Post-operative Urinary retention is a known post-operative complication with a large ranging incidence. It is a multi-factorial etiology that involves established neural pathways that switch reciprocally between control of the bladder and of the urethral outlet. Benign prostatic hypertrophy (BPH) and other urological cancers have been implicated as well. Although it has been described in hypogastric artery embolization as well as thoracic endograft placement, it has not been characterized in infra-renal endovascular aortic aneurysm repair.
METHODS:
All patients who underwent elective EVAR at a single Veterans Affairs Medical Center from December 2010 to March 2016 were included. Patient characteristics and clinical data such as age, body mass index, comorbidities, proximal EVAR graft diameter, distal iliac graft diameters, if hypogastric embolization was undertaken, length of stay, post-operative urinary retention complications, date of death, BPH diagnosis, BPH medical management, and diagnosis of bladder and/or prostate cancer. Urinary retention (UR) was compared to no urinary retention (no UR).
RESULTS:
A total of 134 entries had complete records. 8.2% (n=8) patients had urinary retention. The percentage of hypogastric embolization (27.2% vs. 20%; p=0.79**), BPH diagnosis (54.5% vs. 27.6%; p=0.08**) and bladder/prostate diagnosis (9.1% vs. 16.2%; p=1.0**) was significantly different between the UR and no UR groups respectively.
| UR n=11 | No UR n=123 | p value | |
| Aortic Graft Proximal Diameter (mean ± SD) | 31.6 ± 3.3 | 28.3 ± 4.0 | 0.01* |
| Maximal Iliac Extension Diameter (mean ± SD) | 21.3 ± 4.8 | 18.0 ± 4.5 | 0.02* |
| Hypogastric Embolization (%) | 27.2% | 15.4% | 0.38** |
There was no significant difference in the patient comorbidities (including age) except lower significant rate of coronary artery disease in the UR compared to the No UR group (18.2% vs. 45.5%; p=0.004**).
CONCLUSIONS:
In our analysis, we found an approximately 8.2% incidence of post-operative urinary retention. Increased proximal main body aortic graft diameter as well as larger iliac graft extension diameters correlated with urinary retention. These data indicate a possible connection with aortic and/or iliac artery manipulation as an etiology that interacts with the possible neurological basis of this post-operative complication.
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