An Investigation of Potential Risk Factors for Postoperative Urinary Retention Following Cesarean Section

Yıl 2015, Cilt: 22 Sayı: 1, 8 - 12, 17.04.2015

Sabri Cavkaytar Mahmut Kokanalı Ali Güzel Bergen Laleli Umut Göktürk Demet Kokanalı Yasemin Taşçı

Öz

Abstract

Objectives: To investigate the risk factors for postoperative urinary retention following cesarean section.

Materials and Method: 135 female patients in Ankara Zekai Tahir Burak Woman’s Health, Training and Research Hospital who underwent cesarean section were included in the study. Women who had postvoidal residual bladder with a volume of ≥150 ml measured by ultrasonography were the main group of patients. Women with postvoidal residual bladder with a volume of <150 ml were the control group patients. Demographic data such as age, parity, body mass index weight gain during pregnancy as well as obstetrical characteristics including gestational age and indications of cesarean section, number of cesarean section, anesthesia type, estimated blood loss during cesarean section, birth weight of newborn, presence of labor induction with intravenous oxytocin infusion before cesarean section were all among the data we collected throughout our research. At the end, a logistic regression model was performed to analyze the possible risk factors for postoperative urinary retention following cesarean section.

Results: We detected postoperative urenary retention in 21 (%15.6) patients. There were statistically significant relationships between the potential risks of postoperative urinary retention and the gain weight in the logistic regression model (Odds Ratio=20.8; 95; Confidence Interval=1.8-245.9; p=0.016), birth weight (>4000 gr) (Odds Ratio=0.1, 95%; Confidence Interval=0.0-0.5; p=0.002), birth induction before the cesarean section (Odds Ratio=0.2, 95%; Confidence Interval =0.0-0.8; p=0.027), and the presence of pain in the first urination after removing the urinary catheter (Odds Ratio=92.9, 95%; Confidence Interval =6.6-1299.0; p=0.001). 

Conclusion: Postcesarean urinary retention risk increases if there is increased weight gain during pregnancy, macrosomic newborn delivery, cesarean section subsequent to labor induction, and high pain perception during the first urination after cesarean section.

Key Words: Urinary Retention; Cesarean Section; Risk Factors.

 

Sezaryeni Takiben Gelişen Postoperatif İdrar Retansiyonu İçin Potansiyel Risk Faktörlerinin Araştırılması

 

Özet

Amaç: Sezaryeni takiben gelişen postoperatif idrar retansiyonunun potansiyel risk faktörlerini araştırmak bu çalışmanın amacıdır.

Gereç ve Yöntem: Ankara Dr Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesinde Ocak 2014 ve Mayıs 2014 tarihleri arasında sezaryene alınan 135 hasta çalışmaya dahil edildi. Ultrasonografi ile işeme sonrası mesane hacmi ≥150 ml olan kadınlar çalışma grubu olarak olarak tanımlandı. İşeme sonrası mesane hacmi < 150 ml olan kadınlar ise kontrol grubunu oluşturdu. Bütün kadınlar yaş,parite,vücut kütle indeksi gibi demografik bilgileri ile gebelikte kilo alımı,gestasyonel yaş,sezaryen endikasyonu,sezaryen sayısı,anestezi tipi,sezaryen sırasında tahmini kan kaybı,yenidoğanın kilosu,sezaryen öncesi doğum indüksiyonunun varlığı açısından değerlendirildi. Lojistik regresyon modeli sezaryeni takiben gelişen postoperatif idrar retansiyonunun potansiyel risk faktörlerini analiz için yapıldı.

Bulgular: 21 (%15.6) kadında postoperatif idrar retansiyonu tespit edildi. Lojistik regresyon modelinde gebelikte kilo alımı (Odds Ratio =20.8; 95 Confidence Interval=1.8-245.9; p=0.016), doğum ağırlığı >4000 gram olan bebek doğurmak (Odds Ratio =0.1, 95% Confidence Interval=0.0-0.5; p=0.002) sezaryen öncesi doğum indüksiyonu (Odds Ratio =0.2, 95% Confidence Interval =0.0-0.8; p=0.027), idrar kateterinin çekilmesinden sonraki ilk işemede ağrı olması (Odds Ratio =92.9, 95% Confidence Interval =6.6-1299.0; p=0.001) sezaryeni takiben gelişen postoperatif idrar retansiyonunun potansiyel risk arasında istatiksel olarak anlamlı bulundu.

Sonuç: Sezaryeni takiben gelişen postoperatif idrar retansiyonu riski gebelikte fazla kilo alımı, makrozomik bebek doğurma hikayesi, sezaryenden önce doğum indüksiyonu alınması ve idrar kateterinin çekilmesinden sonraki ilk işemede ağrı olması gibi durumlarda artar.

Anahtar Kelimeler: İdrar Retansiyonu; Sezaryen; Risk Faktörleri.

Anahtar Kelimeler

İdrar Retansiyonu; Sezaryen; Risk Faktörleri

Kaynakça

• Khunpradit S, Tavender E, Lumbiganon P, Laopaiboon M, Wasiak J, Gruen RL. Non-clinical interventions for reducing unnecessary caesarean section. Cochrane Database Syst Rev. 2011;15:(6):CD005528.
• Onile TG, Kuti O, Orji EO, Ogunniyi SO. A prospective randomized clinical trial of urethral catheter removal following elective cesarean delivery Int J Gynaecol Obstet. 2008;102:267-70.
• Zaki MM, Pandit M, Jackson S. National survey for intrapartum and postpartum bladder care: assessing the need for guidelines. BJOG 2004;111:874–6.
• Yip SK, Brieger G, Hin LY, Chung T. Urinary retention in the post-partum period. The relationship between obstetric factors and the post-partum post-void residual bladder volume. Acta Obstet Gynecol Scand 1997;76:667–72.
• Mulder FE, Schoffelmeer MA, Hakvoort RA, Limpens J, Mol BW, van der Post JA, Roovers JP. Risk factors for postpartum urinary retention: a systematic review and meta-analysis. BJOG. 2012;119:1440-6.
• Baldini G, Bagry H, Aprikian A, Carli F, Phil M. Postoperative urinary retention. Anesthetic and perioperative considerations. Anesthesiology. 2009;110:1139-57.
• Chai AHL, Wong T, Mak HLJ, Cheon C, Yip SK, Wong ASM. Prevalence and associated risk factors of retention of urine after caesarean section. Int Urogynecol J Pelvic Floor -Dysfunct. 2008;19:537-42.
• Celik Y. Biostatistics, principles of research. Diyarbakir: Dicle University Press; 2007.
• Poston GJ, Joseph AEA, Riddle PT. The accuracy of ultrasound in the measurement of changes in bladder volume. Br J Urol 1983;55:361–3.
• Liang CC, Chang SD, Chang YL, Chen SH, Chueh HY, Cheng PJ. Postpartum urinary retention after cesarean delivery. Int J Gynaecol Obstet. 2007;99:229-32.
• Musselwhite KL, Faris P, Moore K, Berci D, King KM. Use of epidural anesthesia and the risk of acute postpartum urinary retention. Am J Obstet Gynecol. 2007;196:472.
• Kate J. Study finds no need to catheterize before C-section. OB/GYN News, 15 2001;36:3.
• Cunningham FG, MacDonald PC, Gant NF (eds). Williams Obstetrics. 22nd edn 2005.McGraw-Hill: New York.
• Yip SK, Brieger G, Hin LY, Chung T. Urinary retention in the post-partum period: rhe relationship between obstetric factors and the post-partum post-void residual bladder volume. Acta Obstet Gynecol Scand 1997;76:667-72.
• Yip SK, Sahota D, Pang MW, Chang A. Postpartum urinary retention. Acta Obstet Gynecol Scand 2004;83:881-91.
• Liang CC, Chang SD, Wong SY, Chang YL, Cheng PJ. Effects of postoperative analgesia on postpartum urinary retention in women undergoing cesarean delivery. J Obstet Gynaecol Res. 2010;36:991-5.
• Sarvela J, Halonen P, Soikkeli A, Korttila K. A double blinded, randomized comparison of intrathecal and epidural morphine for elective cesarean delivery. Anesth Anal. 2002;95:436-40.
• Gadsen J, Hart S, Santos AC. Post-cesarean delivery analgesia. Anesth Anal. 2005;101:62-9.
• Dahl JB, Jeppesen IS, Jorgensen H, Wetterslev J, Moiniche S. Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing cesarean section with spinal anesthesia. A qualitative and quantitative systematic review of randomized controlled trials. Anesthesiology. 1999;91:1919-27.
• Tammela T. Postoperative urinary retention: why the patient cannot void. Scand J Urol Nephrol 1995;29:75-7.
• Pifarotti P, Gargasole C, Folcini C, Gattei U, Nieddu E, Sofi G, Buonaguidi A, Meschia M. Acute post-partum urinary retention: analysis of risk factors, a case-control study. Arch Gynecol Obstet. 2014 Jan 21. [Epub ahead of print]