Abstract

Postoperative urinary retention is one of the most common complications of anesthesia and surgery. It occurs more frequently after lower abdominal and pelvic, gynecologic and anorectal surgeries. Management of Postoperative urinary retention is fairly straightforward. The goal is to decompress the bladder to avoid long-term damage to bladder integrity and function. Immediate catheterization is always the first step. Although placement of an indwelling foley catheter is easier, there are several drawbacks to prolonged use of this method. It seems that prevention is better than treatment.

Method and Material- A hospital-based prospective study was carried out in 120 female patients, were divided in two groups, 60 patients in each group, which were presented in department of General Surgery, Mata Chanan Devi hospital, New Delhi, during the time period of 2014-2015. It is a 210 bedded, tertiary care hospital in west Delhi, where the patients travel from all northern India. 

Result- The 60 women of Non Tamsulosin group had mean age of 42.28  8.88 years with the minimum age of 24 years and maximum of 65 years. The 60 patients of Tamsulosin group had mean age of 43.9  8.73 years with the minimum age of 30 years and maximum of 58 years. The mean duration of procedure in non tamsulosin group was 49.0 18.43 min; with minimum duration was 25 min and maximum duration was 85 min. The mean duration of procedure in tamsulosin group was 48.33  16.41 min; with minimum duration was 25 min and maximum duration was 85 min. The mean value of fluid during procedure in non tamsulosin group was 488.33 ± 236.57 ml, with minimum value was 100 ml and maximum was 1000 ml. The mean value of fluid during procedure in tamsulosin group was 551.5 ± 241.54 ml, with minimum value was 120 ml and maximum was 1000 ml. Post voiding residual volume was calculated by ultrasonography. The mean value of post voiding residual volume in our study in non tamsulosine group was 151.5 ± 125.71 ml. and median 120 ml with minimum 30 ml and maximum 600 ml. The mean value of post voiding residual volume in our study in tamsulosine group was 67.17 ± 25.32 ml. and median 60 ml with minimum 30 ml and maximum 150 ml.  Postoperatively out of the 60 enrolled patients who received tamsulosin, none of the patients developed urinary retention after procedure and out of 60 patients in non tamsulosin group, 8 patients were developed urinary retention after procedure. P value is 0.006 which is statistically significant. It implies that use of tamsulosin prevent the urinary retention. Out of 60 patients of non tamsulosin group 18 patients required intervention for urination. 10 patients urinate after encouragement and hot water bottle application, 8 patients required foley’s catheterization. Out of 60 patients of tamsulosin group 2 patients required intervention for urination. Both 2 patients urinate after hot water application, none of them required foley’s catheterization.  P value is 0.0001, which is statistically significant. Of the 60 enrolled patients who received tamsulosin, 4 (6.67%) patients developed side effects after drug intake and out of 60 patients in non tamsulosin group, 0 patients were developed side effects after drug intake. P value is 0.119 which is statistically nonsignificant. In univariate with one unit increase in fluid during procedure, Risk of retention significantly increases by 4%. In univariate with one unit increase in duration of procedure, Risk of retention significantly increases by 12.3%. In univariate with one year increase in age, Risk of retention significantly increases by 12.9% . After adjusting for confounding variables, only duration of procedure significantly affect risk of retention by 12%.  

Conclusion- In our study, tamsulosin significantly prevent the postoperative urinary retention. Side effect of Tamsulosin was statistically insignificant. In our study postoperative urinary retention depend upon duration of surgery, amount of fluid during procedure and age of patients.

Recommendations- Tamsulosin can be used to prevent postoperative urinary retention. It prevent postoperative urinary retention and intervention for that, so prevent catheter related complications. If clinical presentation suggests long duration of surgery and excess amount of intraoperative fluid tamsulosin help in preventing postoperative urinary retention.