Being unable to pass urine after surgery (post-operative urinary retention or ‘PO-UR’) affects four out of every 10 patients who have had an operation. It is particularly common in older people having hip or knee replacement surgery.
PO-UR is managed by inserting a tube to drain the bladder, or ‘catheterisation’. This invasive method can lengthen hospital stay and lead to more problems such as infections and damage to the bladder. It can be incapacitating, undignified, distressing and uncomfortable. Some people leave hospital with a tube still in place.
There are many triggers for PO-UR, including age and gender, type of surgery, anaesthetic or pain killers.
This project came from an idea by patient contributor Nick, who experienced post-operative urinary retention and was given a catheter after three different common non-urgent surgical procedures. He submitted it as an idea for research through the CLAHRC West open call in 2016. He has worked as a researcher alongside the rest of the project team in a pioneering form of co-production.
This project aimed to review the literature, to identify the factors influencing whether a patient will develop PO-UR and what can be done to prevent and treat it.
What we found and what this means
We found factors associated with PO-UR included being older, male, and having previous urinary problems or long-term enlargement of the prostate gland restricting the ability to urinate (‘benign prostatic hyperplasia’). Reducing fluids and using a catheter during surgery were associated with a lower risk of PO-UR.
Giving tamsulosin (a drug used to help men with prostate disease) before surgery can reduce the number of people who develop PO-UR. All the studies of tamsulosin were in men and none were in UK settings, so more studies are needed to see if similar effects are found in women and in UK settings.
Replacing or avoiding morphine in the anaesthetic, administering the anaesthetic in certain ways, and getting patients up and moving as soon as possible after their operation reduced the chance of developing PO-UR. For people who developed it, a small number of studies also suggested that a hot pack or warm gauze and a warm coffee could help.
Based on the results of our review, we developed an intervention to reduce the risk of developing PO-UR – the ‘PO-UR prevention package’. This package involves providing hospital staff with training and advice to:
- Avoid using morphine or reducing the dose, wherever possible
- Change other aspects of the anaesthesia or analgesia
- Get people moving as soon as possible after their operation
- Reduce fluids as far as is safe, before and during the operation
- Provide a hot caffeinated drink and hot pack placed on the abdomen around two hours after the operation
We are planning a new study to find out whether:
- introducing the ‘PO-UR prevention package’
- giving tamsulosin before surgery
will reduce the number of people who develop PO-UR.
The main outcomes we’ll be looking at for this study are:
- whether patients have a catheter before leaving hospital
- how long the catheter stays in
- how long they need to remain in hospital and whether they go home catheterised
Reducing PO-UR should improve patient experience and dignity, shortening their time in hospital and speeding recovery, as well as saving money for the NHS.
CLAHRC BITE (Brokering Innovation Through Evidence)
- Paul Abrams, University of Bristol
- Anthony Blacker, University Hospitals Coventry and Warwickshire
- Nick, patient contributor