Patient-controlled analgesia and postoperative urinary retention after hysterectomy for benign disease

Because postoperative urinary retention can result in considerable morbidity and the rate of retention after hysterectomy has recently increased at our institutions, we conducted a study to determine risk factors for the disorder.

A cohort of 366 consecutive patients who had undergone uncomplicated abdominal or vaginal hysterectomy for benign disease and who met strict inclusion criteria were studied retrospectively by means of a review of their medical records. Student's t test and multivariate logistic regression analysis were used to assess the effects of operative time, amount of fluid given perioperatively, type and amount of analgesic agent administered postoperatively, age of the patient, performance of a vaginal versus an abdominal hysterectomy, and the postoperative use of patient-controlled analgesia on the rate of postoperative urinary retention in these patients.

After adjustment for confounding factors, only the use of patient-controlled analgesia (p = 0.0001) and vaginal hysterectomy (p = 0.0003) were significantly related to postoperative urinary retention. Patients who used patient-controlled analgesia were 5.7 times (95 percent confidence interval, 2.6 to 12.4) more likely to have urinary retention than those given an intramuscular agent.

Urinary retention after hysterectomy might be avoided by administering analgesic agents intramuscularly or inserting a suprapubic cystostomy catheter postoperatively, especially in patients who have undergone a vaginal procedure.