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Introduction - Postoperative urinary retention following neurosurgical procedures is a common occurrence. We retrospectively evaluated men undergoing lumbar spinal fusion to determine which factors predict failure of postoperative voiding trial.
Methods - Over a two-year period, 214 men underwent lumbar spinal fusion by a single neurosurgeon. We excluded men with previous prostate or urethral surgery, a history of urinary retention, men taking alpha-blockers or five alpha-reductase inhibitors, and men with prolonged hospital stay, leaving 148 men evaluable. All men left the operating room with a foley catheter in place and were given a void trial on the day of anticipated discharge. Twenty-three men were unable to void after eight hours and had their foley catheters replaced; they were discharged next day with an appointment for urologic follow-up. These men were compared to successful voiders with respect to comorbid medical conditions, age, surgical placement of hardware, operative time, lumbar level, multiple level fusion, and surgical approach.
Results - Using multivariable analysis, successful postoperative voiders were compared with men who failed the initial voiding trial. Only insulin-dependent diabetes mellitus (p-value less than 0.01) and multiple lumbar level surgery (p-value less than 0.01) were predictive of initial postoperative failure of voiding trial.
Conclusion - Men scheduled to undergo lumbar fusion who have insulin-dependent diabetes or who will require multiple level intervention may benefit from preoperative initiation of alpha blockade at the time of scheduling, as well as an inpatient postoperative urologic consultation.