Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair
Authors: Croghan Stefanie M. , Mohan Helen M. , Breen Kieran J. , McGovern Ruth , Bennett Kathleen E. , Boland Michael R. , Elhadi Muhammed , Elliott Jessie A. , Fullard Anna C. , Lonergan Peter E. , McDermott Frank , Mehraj Asif , Pata Francesco , Quinlan David M. , Winter Des C. , Bolger Jarlath C. , Fleming Christina A. ,   RETAINER I Study Group of the Irish Surgical Research Collaborative, Farinelli Pablo Alberto , Alaniz Alday Maria Jimena , Avellaneda Nicolás L. , Goya María M. , Clementé Gastón A. , Lopez Juan Cruz , Proud David , Shulman Natassia , Huang Dora , Jamel Wael , Gill Sonia , Arthur Thomas , Swindon Daisy , Frank Amy , Teng Roy , Chua Irene , Chong Nicole , Hannigan Amy , Srinivasan Madhu , Al Bastaki Aysha , Ahmad Sharifa , Juma Isam , Yang Wah , Wang Huaxi , Jiang Shuwen , Lincango Naranjo Eddy P , Dominguez Carla M , Huilca Luis F , Negrete Ocampo Jose R , Nafea Ahmed , Awad Ahmed K. , Elbadawy Merihan A. , Abdulmonem Aya Abdulilah , Abdelgalil Mahmoud Shaban , Helmy Salma Tarek , Abd El-razik Sally Ahmed , Mabrouk Laila Raafat , A.Rady Ahmed Hassan , Shaheen Ahmed , Ewedah Moataz , Farag Marina , Tanas Yousef , Dean Yomna , Ghanem Maha , Asla Amir F. , Ghatwary Ahmed M. , Elsadek Menan A. , Saad Aalaa , Hassan Ramy A. , Herdan Mohamed O. , Nassar Mahmoud A. , Alaa Sherif , Khamis Areej A. , Youssef Hadeer M.S. , El Sherpiny Mohamed A. , Shehata Eslam S.A.M. , Taha Sandy A. , Zahran Ahmed A.A.A , Al-Nagdy Mohamed , Sayed Hafez Somaya Z.E , Abo Ghanima Shymaa M. , Farahat Sherif , Morgan Fatma M. , Mahfouz Shaimaa M. , Elfeki Hossam , Elghadban Hosam , Shalaby Mostafa , Shetiwy Mohamed , Mostafa Mohamed , Sakr Ahmad , Elsayed Ahmed , Sadek Kareem , Eldeghedi Maher , Nader Mohamed , Elsaadany Reem , Hesham Yousef , Attiya Omar , Shaaban Abdelrahman , Sakr Yara , Alharazin Mohammed , Omar Mohammed A. , Alansary Marwa N. , Ebada Mahmoud A. , Abdelfattah Mohamed S. , El-Taher Ahmed K. , Ghaith Hazem S. , Abdelhaleem Ibrahim A. , Fayed Notaila M. , Fayed Laila , Mahmoud Mohamed K. , Mohamed Esraa E. , El-Deeb Amr M. , Mohamed Islam M. , El kady Abd Elrahman S. , Abd Al-Fattah Mohammed , Hassaan Mohamad , Hegazy Mohammed G. , Asla Amir Fathi , Fradelos Evangelos , Korkolis Dimitrios , Kavalieratos George , Manatakis Dimitrios K. , Tasis Nikolaos , Ioannidis Argyrios , Konstantinidis Michael , Konstantinidou Sofia , Koukoulis Georgios , Kalfountzos Christos , Bouliaris Konstantinos , Schizas Dimitrios , Machairas Nikolaos , Kykalos Stylianos , Vailas Michail , Syllaios Athanasios , Dorovinis Panagiotis , Kozadinos Alexandros , Bouchagier Konstantinos , Mulita Francesk , Skroubis Georgios , Maroulis Ioannis , Chatzimavroudis Grigorios , Kotoreni Georgia , Sountoulides Petros , Agalianos Christos , Antonopoulou Maria Ioanna , Ladoukakis Aristeidis , Nikolouzakis Taxiarchis K. , Lasithiotakis Konstantinos , Chrysos Emmanuel , Xenaki Sofia , Baili Efstratia , Liakakos Theodore , Charalabopoulos Alexandros , Al-Juaifari Maytham A. , Zwain Yasir A. , Himi Ahmed A. , Aldawoody Hogir I.R. , Balasubramanian Ishwarya , Hill Arnold D.K. , Robb William B. , Aketch Martin Safari , Brady Aaron M.J. , O' Leary Peter D. , Elliott Jessie A. , Davis Niall F. , Creavin Ben , Ridgway Paul F. , Barry Kevin , Kelly Orlaith , Raftery Nicola , Davey Matthew G. , McLaughlin Ray P. , Joyce William P. , Meldon Aengus , Fullard Anna , Nugent Emmeline , Dhannoon Amenah , Carroll Paul , O'Brien Stephen J. , Andrews Emmet , Foley Niamh M. , Killeen Shane , Hechtl Daniel , O'Riordain Michael , Conneely John B. , Hardy Niall P. , McInerney Niall J. , Kearns Emma C. , Shanahan Ben , Kennedy Czara , Toomey Desmond , Mansoor Shabhaz , Ryan Eanna , Johnston Sean M. , Lim Sean T. , Ahonkhai Irele Ifijeh , Eltagani Eltahir , Ryan Odhran K. , Earley Helen , Garvin Joseph , Iruthayanathar Andru Nitharasan , Clancy Cillian , Fahey Brian , Rashid Haroon , McCormick Paul , Reynolds Ian S. , Garrahy Darragh , Bean Orlagh , Conlon Eoin , Winter Des C. , Molony Emily , Martin Sean T. , Hoti Emir , Stafford Anthony T. , Hanly Ann , Maguire Donal , Ng Kin Cheung , Wong Benjamin Ngie Xiong , McCormack Tom , Chan Kin Yik , Peirce Colin , Coffey Calvin , Nabi Nauman , Jacob Prem Thomas , Dillon Patrick , Ahmad Abrar , Neary Peter , Ryan Jessica M. , Connelly Tara M. , Cooke Fiachra , McCullough Peter W. , Pellino Gianluca , Selvaggi Lucio , Selvaggi Francesco , Gallo Gaetano , Pata Francesco , Riboni Cristiana , Danzi Michele , De Luca Marcello , Lionetti Ruggero , Grimaldi Luciano , Corcione Francesco , Manigrasso Michele , Milone Marco , De Palma Giovanni Domenico , Biancafarina Alessia , Mariottini Valentina , De Prizio Marco , Solaini Leonardo , Cavaliere Davide , Vigutto Gabriele , Castaldi Antonio , Palumbo Alessio , Antropoli Carmine , Ripetti Valter , Luffarelli Paolo , Capolupo Gabriella T. , Caricato Marco , Carannante Filippo , Grassia Michele , Lucchi Andrea , Schimera Antonio , Palomba Giuseppe , Aprea Giovanni , Feo Carlo V. , Fabbri Nicolò , Torchiaro Marco , Mazza Marcodomenico , De Marco Paolino , Bagaglini Giulia , Grande Michele , Lapolla Pierfrancesco , Mingoli Andrea , Brachini Gioia , Pipitone Federico Nicoletta Sveva , Calabrò Marcello , Murgese Alessandra , Aiolfi Alberto , Mini Emanuele , Bona Davide , Patrone Renato , Nasto Aurelio , Pertile Davide , Scabini Stefano , Soriero Domenico , Massobrio Andrea , Deiana Selene , Carganico Giacomo , Montuori Mauro , Pinotti Enrico , Carrara Giulia , Lisi Giorgio , Spoletini Domenico , Menditto Rosa , Pace Marco , Petrucciani Niccolò , Nigri Giuseppe , Sasia Diego , Girardi Martina , Giraudo Giorgio , Andreuccetti Jacopo , Rossi Stefano , Scorsi Alessandro , Puccioni Caterina , Picardi Biagio , Anastasi Alessandro , Borreca Riccardo , Adinolfi Elvira , Canonico Giuseppe , Nelli Tommaso , Carmignani Francesco , Baldini Edoardo , Boccia Olivia , Kersik Alessia , Fleres Francesco , Clarizia Guglielmo , Longhini Alessandro , Mariani Nicolo , Balla Andrea , Lepiane Pasquale , Petrocca Sergio , Ranucci Maria Chiara , Morelli Luca , Di Franco Gregorio , Porcelli Francesco , Guadagni Simone , Furbetta Niccolò , Romanzi Andrea , Milanesi Maria , Vignati Barbara , Vannelli Alberto , Scolaro Roberta , Putortì Antonella , Khamees Almu'atasim , Almasarweh Sami A. , Guboug Ali , Abu-Ismail Luai , Al-Shami Khayry , Awadi Sajeda , Haij Manal Zain Mohammed , Alrayes Bourhan M.H. , Al-Kubaisy Manolia , Rashdan Mohammad , Abufaraj Mohammad , Mansour Hanan , Toubasi Ahmad A. , Azzam Muayad , Al-Aydi Tala , Bsisu Isam , Khrais Oweiss , Bani Hani Mohammad , Daradkeh Hamza , Jamous Hussam , Dardour Mohammad , Msameh Renad , Alasawdeh Hadeel , Shumrakh Saeed K. , Oqdeh Yahya F. , AL Hamoud Mohammad A. , Abuleil Amro , Ababneh Hazim Sameer Mohammad , Elhadi Muhammed , Hasan Wisam A. , Ali Ebrahim M. , Khalil El Sharif F. , Abaidalla Ahmed Faraj , Il Haddad Haifaa , Amnaina Mohamed G. , Alabd Husayn M. , Bahroun Sumayyah G. , Younes Eman , Al Sagheir Eman , Ali Ali , Khamaj Malak , Ashfersh Mohamed , Ekhmaj Reyad , Abuzeid Issa A. , Albaraesi Mohammed N. , Taktuk Salah S. , Aldressi Wafa , Eltaeb Khalid F. , Gomaty Jamal M. , Bakeer Hibah Bileid , Alkaseek Akram Mohammed , Alarabi Rehab , Gjam Fatima Z. , Elhajdawe Fras A.D. , Shuayb Ahlam M. , Egdeer Amin , Almugaddami Ayman , Abdulwahed Eman A. , Ghmagh Reem , Alshareea Entisar , Gidiem Doaa , Askar Aamal , Aljamal Sarah , Deeknah Abdulqudus , Biala Marwa , Barka Sharf , Kamour Khaula , Alameen Hind , Abozid Anwaar , Alsori Mohamed , Kanna Sanad , Elgadi Tahani , Naana Reyam , Marwan Abdulrhman , Omar Osama , Teoh Jeremy Y.C. , Ahmed Fathil Ida Nadiah , Adwin Zainal Z. , Elshami Mohamedraed , Alvarez-Lozada Luis Adrian , Durán-Castro Daniela G. , de la O-Escamilla Manuel E. , Arrambide-Garza Francisco J. , Muñoz-Maldonado Gerardo E. , Quiroga-Garza Alejandro , El Azzazi Hind , El Assaad Yousra , Mrissa Yassine , Koukou Mouad , Varghese Chris , Alqassab Mohammed K. , Barnes Tracey , Thompson-Fawcett Mark W. , McGuinness Matthew , Mitchell Josh , Grinlinton Megan , Auchterlonie Rowan , Hasiata Vilingatoni , Harmston Christopher , Allen-Brough Chelsea , Siggins Lauren , Weeratunga George , Lin Anthony , Xu William , Cook Holly , Ghamri Nusr , Joseph Nejo , Zheng Helen , Ratnayake Milidu V.B. , Bissett Ian P. , Adeyeye Ademola Adetoyese , Olayinka Mohammed Taofiq , Alfa Yakubu , Daniyan Muhammad , Tolani Musliu Adetola , Bashir Muhammed , Musa Keffi Mubarak , Omon Henry Ehidiamen , Balogun Simon Adewale , Anele Christopher Obinna , Adesunkanmi Abdul Hafiz O. , Ajekwu Samuel Chibuzo , Afeikhena Ehis , Egbuchulem Ifeanyichukwu Kelvin , Constantine Ezeme , Olagunju Naomi , Ikechukwu Ulasi Bartholomew , Fakoya Adegbolahan , Ogundoyin Olakoyode O , Waqar Usama , Ukrani Ronika Devi , Mansoor Maheen , Asghar Tofique , Jamaluddin Muhammad , Zahid Muhammad , Ali Farjad , Chawla Tabish , Aamir Faiqa B. , Tahir Izza , Farhan Emaan , Dar Kamran H. , Saeed Abdullah B. , Shahbaz Usama , Alozai Muhammad Ilyas , Akram Muhammad U. , Haider Sohaib , Hai Arrham , Ahmed Shaheer , Hussain Akbar , Durrani Ahmed M. , Arbi Fawad M. , Khaliq Fatima , Abubakr Muhammad , Khalid Noor , Khalid Rizwan , Iqbal Aqsa , Javed Arwa , Akhtar Hamza , Malik Bilal M. , Khan Hashim , Butt Adam U.A. , Malik Abdur R. , Malick Daniya S. , Asif Aiza , Khan Muhammad Sarfraz , Anwar Muhammad Idrees , Yaqoob Sadia , Jarullah Furqan A. , Umer Farooq , Jamil Soomal , Zarin Mohammad , Khan Adel , Alam Mansoor , Shafi Mahnoor , Fakhar Samra , Ayaz Ali Amrat , Dal Nawaz A. , Shams Marvi , Laghari Sundas , Kumar Yash , ul Haq Syed Atif , Abdullah Areeba , Ur Rehman Sheeraz , Javed Farhan , Ali Wasaq , Ahmad Shahzaib , Joshi Prabesh , Sarwar Muhammad Zeeshan , Naqi Syed Asghar , Daula Muhammad I.H. , Ijaz Muhammad Tayyab , Fazal Talha bin , Javaid Amna , Rajput Akram , Masroor Layiba , Shahab Tooba , Yaqub Aimen , Zahid Sufian M. , Jabbar Naveed , Javeed Muhammad Hassan , Karim Muhammad Qaisar , Jamal Muhammad Asad , Fazal Mishaal , Hameed Fahd Mudassar , Bakhtiar Mahnoor , Akhtar Aamena , Khan Zartaj A. , Rehman Kiran , Khan Rehan A. , Farooqui Fareeha , Aimon Sibgha , Marjan Iqra , Al-Saba'a Yousef K. , Alkahlout Dana M. , Amer Fatima M. , Mostafa Omar , Naim Deema Sami , Manasra Mahmoud , Giacaman Yazan , Zawahra Aya , Erman Myyas N. , Abu Reyash Tamara K. , Shami Sarah M. , Awwad Amjad H. , Abu-Arish Hamdoon , Y. Aljabarein Osama , Alkomi Saja , Dweik Raghad , Atatra Khalil O. , Yasin Fawzi Hesham , Saad Reem J. , Khader Abdellatif , Hussein Reema A. , Helles Ameer A. , Ismail Ruba S. , Abu Jayyab Mustafa A. , Hasson Mohammad , Povo Ana , Silva Cláudio , Ginestal Mariana , Negoi Ionut , Negoita Valentina M. , Talpai Tamás , Pîrvu Cătălin-Alexandru , Pantea Stelian , Menzulin Ruslan , Yanishev Alexey , Bazaev Andrey , Chubukova Natalia , Bagrjancev Maxim , Ryabkov Maxim , Abelevich Alexander , Novikova Anastastia , Saeed Reham J.M. , El-Mansoury Tarek M. , Khogaly Amer M.A. , Galun Danijel , Zivanovic Marko , Serrano-Navidad Monica , Landaluce-Olavarria Aitor , Estraviz- Mateos Begoña , Sainz-Lete Aitor , Gonzalez-De Miguel Melania , Zevallos-Quiroz Julio , Vázquez-Melero Alba , Sánchez-Rubio María , Herrero López Imanol , García López de Goicoechea David , Camuera González Maite , Helguera Martínez Pablo , Balluerca Alba María , Paunero Vázquez Patricia , Soeda Seminario Isami , Mendoza Moreno Fernando , Matías-García Belén , Alvarado-Hurtado Ricardo , Soto-Schütte Sonia , Alberich Prats Marta , Madrazo González Zoilo , López Borao Jaime , Sueiras Gil Albert , Martin Santos Silvia , Gil Barrionuevo Marta , Rodriguez-Leon Gerardo , Vallet Fernandez Josep , Ortiz Rodriguez Carles , Hevia Falú Ramiro , Gil Gomez Vicente , Biel Arrufat Alex , Alberca Páramo Ana , Antonaya Rubia Eva , Rodríguez Cano María A. , Ruíz Frías Piedad , Gortázar de las Casas Sara , Del Castillo Díez Federico , Guevara Martínez Jenny , Prieto La Noire Fernando , Chavarrías Torija Nuria , Valderrabano Gonzalez Santiago , Heras Garceau María , Otero de Pablos Jaime , Ramos Bonilla Antonio , Enjuto Martínez Diego T. , Rodríguez Gómez Lorena , Diaz Peña Patricia , Gonzalez Guerreiro Judit , Cervera Celdrán Iria , Cagigal Ortega Elima , García Domínguez Antonio , Alvarez Cuiñas Ana , Soldevila-Verdeguer Carla , Fernández-Vega Laura , Pagès-Valle Naila , Coello-González Alejandro , Colás-Ruiz Enrique , Alwis Weerakkodige Mithun Chamindaka , Karunarathne Rathnayake Mudhiyanselage Dulanee , Bandara Ginimal Bandaralage Kavinda Deshapriya , Rodrigo Vitharanage Srimantha Dewsiri , Jayarajah Umesh , Abdulhamid Salaheddin M. , Almokdad Fares Kh. , Senhuri Alrayah E. , Abdullah Weaam M. , Abdelwahid Elharith H. , Idris Alhaj O. , Galal-Eldin Sami , Hamid Hytham K.S. , Mohammed Alaa M.E. , Ibrahim Ahmed M. , Ahmed Samar G. , Osman Osama S. , El Tahier Abdalla Omer Mohammad , Toum Fthelrahman M. , Mohammed Sabir Fatima , Yaghoub Ali Abdulhafiz , Abdelmageed Abdelfatah A. , Khalafalla Ashraf , Hassan Luden Saif Aldawla , Mahmoud Mai D. , Salih Mugahid A. , Hamdan Alaa , Mohammad Mazen , Al Shareeda Mohamad , Otaky Mohammad Baraa , Nashed Ali , Zayat Hussein , Aloulou Mohammad , Alsmail Mohamed H. , Sawas Fatima , Alghareeb Rafah , Kudra Danial Aghyad , Abdullah Mohammad A. , Krad Khaled , Masri Ruqaya , Alannaz Omar , Halwani M.Yasser , Ghannam Mohammad Maen , Kazzaz Ranim , Tammo Shergal , Ghazal Ahmad , Alabad Madian , Alhasan Hasan , Alhaj Ahmad , Aljaber Ahmad , Jarkas Bakri T. , Olaisheh Habib , Hassan Bassam , Kayali Ahmad Amir H. , Nasani Mohannad , Kayali Hasan F. , Alahmad Ziad , Arnaout Khaled , Laila Aya A.N. , Zalf Kamal , Hasson Hussain , Apelian Shant N. , Makhluf Hawazen A. , Ibraheem Fadwa F. , Arnaout Ahmad Y. , Ibrahim Hamza , Sharifa Mohammad , Nastah Samer , Zayat Mohammed A. , Tarky Alhashash Ahmad , Konaizeh Dani S. , Rostum Zuhair , Ahmad Hasan Y. , Aliskander Fater , Saad Ahmad , Isik Arda , Memis Ufuk , Salih Saniye , Saracoglu Kemal Tolga , Hokenek Ummahan Dalkilinc , Tatar Ozan Can , Shah Syed Faraz Ali , Cantürk Nuh Zafer , Şahin Enes , Güler Sertaç Ata , Şimşek Turgay , Guldogan Cem E. , Gundogdu Emre , Ozmen Mahir M. , Uprak Tevfik Kıvılcım , Can Şahin Melike Zeynep , Demirli Atici Semra , Teker Kenan , Aktas Ahmed , Latif Javed , McDermott Frank , Lederhuber Hans , Kantola Venla , Muse Samantha , Jaralla Nasir , Roy Dorina , McCoubrey Alison , Botes Azel , Booth Alexander , Edgerton Colston , Al-Eryani Fatima , Al-Naggar Hamza , Al-Eryani Salwa , AL-Wajeeh Ghadeer , Abotaleb Khadega , Al-Shehari Mohammed , Shream Sarah , Alsayadi Ramzi , Alemad Shada , Alshaikh Bushra Hussein , Al-Dhaheri Manal Jamal , Al-Hajj Al-Fakih Wadhah Ahmed , Telha Khaled A. , AlQatta Wail M. , Telha Ghassan K. , Güner  Ali 
Published: July 2023

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.