Defining optimal postvoid residual volume thresholds for predicting delayed postoperative urinary retention in spinal...

Area of Science:

• Urology
• Neurosurgery
• Anesthesiology

Background:

• Postoperative urinary retention (POUR) is a frequent complication after spinal surgery, leading to extended hospital stays and increased morbidity.
• Current diagnostic criteria for POUR, based on two consecutive postvoid residual (PVR) volumes of 300 mL, may not adequately identify patients at risk for delayed retention.

Purpose of the Study:

• To establish refined PVR cut-off values for predicting delayed POUR in spinal surgery patients.
• To stratify these thresholds based on risk factors like gender and age to enhance postoperative voiding care protocols.

Main Methods:

• A retrospective, single-center cohort study of 310 adult patients undergoing elective thoracolumbar spinal surgery.
• PVR volumes were measured post-Foley catheter removal; delayed POUR was defined as PVR > 300 mL after voiding care.
• Multivariable logistic regression and ROC curve analysis were used to identify risk factors and determine optimal PVR thresholds stratified by gender, age, surgical levels, and Anticholinergic drug score (ADS).

Main Results:

• Delayed POUR occurred in 11.9% of patients and was associated with older age, higher initial PVR, and ADS ≥ 2.
• Optimal PVR thresholds for predicting delayed POUR were identified as 61 mL for males (AUC=0.68) and 101 mL for females (AUC=0.77).
• Lower thresholds were indicated for higher-risk subgroups, including those with multiple surgical levels or higher ADS.

Conclusions:

• Refined, stratified PVR cut-off values can effectively predict delayed POUR in spinal surgery patients.
• These findings support a move towards personalized postoperative voiding care, enabling earlier detection and intervention for urinary retention.