Genitourinary Complications Associated with Transcatheter Aortic Valve Replacement
Syed Alam, BA1, Jason K. Frankel, MD1; Elisabeth E. Mulroy, MD1; Richard L. Seip, PhD2, Brett Hiendlmayr, MD2; Stuart Kesler, MD2
1University of Connecticut, Farmington, CT; 2Hartford Hospital, Hartford, CT
BACKGROUND: The use of Transcatheter Aortic-Valve Replacement (TAVR) has quickly gained traction as a mainstay approach in the treatment of symptomatic aortic stenosis in patients who are considered an intermediate or high risk for standard aortic valve replacement. Due to the rapid adoption of this procedure, the associated adverse complications have not been fully described. While originally TAVR was performed strictly under general anesthesia, conscious sedation has become more commonplace. There is growing evidence to suggest that TAVR is often associated with genitourinary (GU) complications. The purpose of this study is to examine GU complications in patients undergoing TAVR and to identify a potential relationship with GU risk factors and anesthesia method.
METHODS: Patients having undergone TAVR were identified from a pre-existing IRB-approved database at Hartford Hospital. Clinical risk factors including type of anesthesia, urethral catheter placement, length of stay, and prior GU history were gleaned from the medical records. Adverse outcomes including hematuria, urinary retention, and the need for GU intervention were recorded. To test for significant differences we employed the Pearson's chi-square (when cell counts were sufficient) or Fisher's exact test (for cells with counts smaller than 5), using a significance level of α<0.05. The Mann-Whitney Ranked Sum test was used for non-normally distributed data.
RESULTS: 201 patients were identified who underwent TAVR at Hartford Hospital between 2012 and 2017. 69.2% of these patients had a urethral catheter placed for the procedure and 36.1% had a GU risk factor, with benign prostatic hyperplasia (BPH) being the most common. The overall GU complication rate was 13.4% with a significantly greater proportion of these complications occurring in men versus women (20.4% vs. 5.4%, p<0.002). The most common GU complications were hematuria and urinary retention. BPH was a statistically significant predictor of GU complication with 38.5% of men with BPH suffering from GU complication compared to 10.1% of those without BPH (p<0.0004) Those who received conscious sedation as opposed to general anesthesia had a significantly lower GU complication rate (7.6% vs. 17.2%, p=0.05). While patients who had a catheter placed for their procedure had a lower GU complication rate, this did not reach statistical significance (p=0.063). Mean length of stay was significantly lower in those without a GU complication.
CONCLUSIONS: History of BPH, male gender, and use of general anesthesia are significantly associated with GU complications in the post-operative period following TAVR. Knowledge of these risk factors may aid cardiology providers in risk stratifying patients who qualify for TAVR while suggesting a change in practice for those who commonly use general anesthesia for TAVR.
Table 1 – Patient Characteristics
| N (%) | |
| Number of Patients | 201 |
| Male | 108 (53.7) |
| Mean age | 82.8 |
| General anesthesia | 123 (61.2) |
| Conscious sedation | 78 (38.8) |
| Preoperatively foley placement | 139 (69.2) |
| Mean length of stay (days) | 5.2 |
| Genitourinary risk factor | 79 (39.3) |
| BPH | 39 (19.4) |
| Prior urologic procedure | 13 (6.5) |
| History of 5-alpha reductase use | 9 (4.5) |
| History of hematuria | 8 (4.0) |
| History of urinary retention | 6 (3.0) |
| History of ADT | 4 (2.0) |
Table 2 – Genitourinary Complications and Risk Factors
| N (%) | p | |
| Genitourinary complications | 27 (13.4) | |
| Hematuria | 11 (40.7) | |
| Urinary retention | 11 (40.7) | |
| UTI | 8 (30.0) | |
| Gender | 0.002 | |
| Male (% of all males) | 22 (20.4) | |
| Female (% of all females) | 5 (5.4) | |
| Type of anesthesia | 0.05 | |
| General anesthesia | 21 (17.2) | |
| Conscious sedation | 6 (7.6) | |
| Foley for procedure | 0.063 | |
| Foley | 22 (16.1) | |
| No Foley | 5 (6.5) | |
| Hx of BPH (Males only) | 0.0004 | |
| Hx of BPH | 15 (38.5) | |
| No Hx of BPH | 7 (10.1) | |
| Mean length of stay in days [st.dev] | .001 | |
| Genitourinary complication | 8.07 [6.7] | |
| No genitourinary complication | 4.82 [4.1] |
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