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Effects of dexamethasone on postoperative urinary retention after laparoscopic inguinal hernia repair

  • 2018 SAGES Oral
  • Published:
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Abstract

Background

Postoperative urinary retention (POUR) is a complication of laparoscopic inguinal hernia repair (LIHR). Previous research has identified predictive factors of POUR, such as age and history of benign prostatic hyperplasia (BPH). There is currently limited work on preventative measures. We hypothesize dexamethasone, a steroid, reduces POUR rates following LIHR due to its mechanism.

Methods

Consecutive patients (n = 979) undergoing LIHR from 2009 to 2017 at a single institution were selected from a prospectively managed database. All procedures were performed by four general surgeons. Only male patients were selected, as the majority of POUR occurs in males. Patients were retroactively chart reviewed and divided into two groups, dexamethasone use (n = 623) and no dexamethasone use (n = 356). Perioperative factors were compared between groups with Chi-square and independent samples t tests. Univariable and multivariable logistic regression analysis was used to assess whether dexamethasone use was associated with POUR. A subgroup analysis was performed on the dexamethasone group to determine any dose-dependent effects.

Results

We found a significant difference in POUR between the dexamethasone group and no dexamethasone group (3.7% vs. 9.8%, p = 0.0001). Patients in the dexamethasone group had a shorter length of stay, and were less likely to have BPH or a Foley placed (all p < 0.05). Age and BMI were similar between groups. Multivariable analysis showed that the use of dexamethasone was associated with a reduced risk of POUR (OR 0.52, 95% CI 0.2–0.97, p = 0.0386), while controlling for factors such as age and BPH. A subgroup analysis examined the effect of dexamethasone per unit (mg) increase. There was no significant association between dexamethasone dose and POUR rates (OR 1.07, 95% CI 0.82–1.38, p = 0.6241).

Conclusions

Patients who received dexamethasone showed a lower rate of POUR regardless of dose. These results suggest dexamethasone can be administered to reduce POUR in males undergoing LIHR.

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References

  1. Rutkow IM (2003) Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin N Am 83:1045–1051

    Article  PubMed  Google Scholar 

  2. Patel JA et al (2015) Risk factors for urinary retention after laparoscopic inguinal hernia repairs. Surg Endosc 29(11):3140–3145

    Article  PubMed  Google Scholar 

  3. Sivasankaran MV, Pham T, Divino CM (2014) Incidence and risk factors for urinary retention following laparoscopic inguinal hernia repair. Am J Surg 207(2):288–292

    Article  PubMed  Google Scholar 

  4. Baldini G, Bagry H, Aprikian A, Carli F (2009) Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology 110(5):1139–1157

    Article  Google Scholar 

  5. Keita H, Diouf E, Tubach F et al (2005) Predictive factors of early postoperative urinary retention in the postanesthesia care unit. Anesth Analg 101:e592–e596

    Article  Google Scholar 

  6. Tammela T, Kontturi M, Lukkarinen O (1986) Postoperative urinary retention I: incidence and predisposing factors. Scan J Urol Nephrol 20(3):197–201

    Article  CAS  Google Scholar 

  7. Blair AB, Dwarakanath A, Mehta A, Liang H, Hui X, Wyman C, Ouanes JPP, Nguyen HT (2017) Postoperative urinary retention after inguinal hernia repair: a single institution experience. Hernia 21(6):895–900

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Darrah DM, Griebling TL, Silverstein JH (2009) Postoperative urinary retention. Anesthesiol Clin 27(3):465–484

    Article  PubMed  Google Scholar 

  9. Hudak KE et al (2015) Surgery duration predicts urinary retention after inguinal herniorrhaphy: a single institution review. Surg Endosc 29(11):3246–3250

    Article  PubMed  PubMed Central  Google Scholar 

  10. Stallard S, Prescott S (1988) Postoperative urinary retention in general surgical patients. Br J Surg 75:1141–1143

    Article  CAS  PubMed  Google Scholar 

  11. Koch CA, Grinberg GG, Farley DR (2006) Incidence and risk factors for urinary retention after endoscopic hernia repair. Am J Surg 191(3):381–385

    Article  PubMed  Google Scholar 

  12. Mohammadi-Fallah M, Hamedanchi S, Tayyebi-Azar A (2012) Preventive effect of tamsulosin on postoperative urinary retention. Korean J Urol 53:419e423

    Article  Google Scholar 

  13. Li H-Z et al (2017) Caution! The potential overestimated effect of prophylactic alpha-blockade for the prevention of urinary retention following primary inguinal hernia repair in a meta-analysis of randomized controlled trials. Am J Surg. https://doi.org/10.1016/j.amjsurg.2017.04.009

    Article  PubMed  Google Scholar 

  14. Clancy C, Coffey JC, O’Riordain MG, Burke JP (2017) A meta-analysis of the efficacy of prophylactic alpha-blockade for the prevention of urinary retention following primary unilateral inguinal hernia repair. Am J Surg. https://doi.org/10.1016/j.amjsurg.2017.02.017

    Article  PubMed  Google Scholar 

  15. Murphy GS, Sherwani SS, Szokol JW, Avram MJ, Greenberg SB, Patel KM, Wade LD, Vaughn J, Gray J (2011) Small-dose dexamethasone improves quality of recovery scores after elective cardiac surgery: a randomized, double-blind, placebo-controlled study. J Cardiothorac Vasc Anesth 25:950–960

    Article  CAS  PubMed  Google Scholar 

  16. Resnick NM, Elbadawi A, Yalla SV (1995) Age and the lower urinary tract: what is normal? Neurourol Urodyn 14:577–579

    Google Scholar 

  17. Wein A, Dmochowski R (2012) Neuromuscular dysfunction of the lower urinary tract. In: Wein A, Kavoussi L, Novick A, Partin A, Peters C (eds) Campbell-Walsh urology, 10th edn. Saunders, Philadelphia, p 1940

    Google Scholar 

  18. Hirst SJ, Lee TH (1998) Airway smooth muscle as a target of glucocorticoid action in the treatment of asthma. Am J Respir Crit Care Med 158(5 Pt 3):201–206

    Article  Google Scholar 

  19. Schramm CM, Grunstein MM (1996) Corticosteroid modulation of Na+/K+ pump-mediated relaxation in maturing airway smooth muscle. Br J Pharmacol 119(5):807–812

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Sacco DE, Daller M, Grocela JA, Babayan RK, Zietman AL (2003) Corticosteroid use after prostate brachytherapy reduces the risk of acute urinary retention. BJU Int 91(4):345–349

    Article  CAS  PubMed  Google Scholar 

  21. Murphy GS, Szokol JW, Greenberg SB, Avram MJ, Vender JS, Nisman M, Vaughn J (2011) Preoperative dexamethasone enhances quality of recovery after laparoscopic cholecystectomy: effect on in-hospital and postdischarge recovery outcomes. Anesthesiology 114(4):882–889

    Article  CAS  PubMed  Google Scholar 

  22. Murphy GS, Szokol JW, Greenberg SB, Avram MJ, Greenberg SB, Shear T, Vender JS, Gray J, Landry E (2014) The effect of single low-dose dexamethasone on blood glucose concentrations in the perioperative period: a randomized, placebo-controlled investigation in gynecologic surgical patients. Anesth Analg 118(6):1204–1212

    Article  CAS  PubMed  Google Scholar 

  23. Toyonaga T, Matsushima M, Sogawa N, Jiang SF, Matsumura N, Shimojima Y, Tanaka Y, Suzuki K, Masuda J, Tanaka M (2006) Postoperative urinary retention after surgery for benign anorectal disease: potential risk factors and strategy for prevention. Int J Colorectal Dis 21(7):676–682

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Section of Minimally Invasive Surgery, Department of Surgery, NorthShore Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA

    Merritt Denham, Kara Donovan, Nicole Wetoska, Kristine Kuchta, JoAnn Carbray, John G. Linn, Woody Denham, Stephen P. Haggerty, Raymond Joehl & Michael Ujiki

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  1. Merritt Denham
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  2. Kara Donovan
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  3. Nicole Wetoska
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  4. Kristine Kuchta
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  5. JoAnn Carbray
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  6. John G. Linn
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  7. Woody Denham
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  8. Stephen P. Haggerty
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  9. Raymond Joehl
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  10. Michael Ujiki
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Correspondence to Michael Ujiki.

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Disclosures

Merritt Denham, Kara Donovan, Nicole Wetoska, Kristine Kuchta, JoAnn Carbray, and Drs. Michael Ujiki, John G. Linn, Woody Denham, Stephen P. Haggerty, and Raymond Joehl have no conflicts of interest or financial ties to disclose.

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Denham, M., Donovan, K., Wetoska, N. et al. Effects of dexamethasone on postoperative urinary retention after laparoscopic inguinal hernia repair. Surg Endosc 33, 3008–3013 (2019). https://doi.org/10.1007/s00464-018-6572-7

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  • DOI: https://doi.org/10.1007/s00464-018-6572-7

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