PATIENT-CONTROLLED ANALGESIA AND POSTOPERATIVE - URINARY RETENTION AFTER HYSTERECTOMY FOR BENIGN DISEASE

BACKGROUND: Because postoperative urinary retention can result in cons iderable morbidity and the rate of retention after hysterectomy has re cently increased at our institutions, we conducted a study to determin e risk factors for the disorder. STUDY DESIGN: A cohort of 366 consecu tive patients who had undergone uncomplicated abdominal or vaginal hys terectomy for benign disease and who met strict inclusion criteria wer e studied retrospectively by means of a review of their medical record s. Student's t test and multivariate logistic regression analysis were used to assess the effects of operative time, amount of fluid given p erioperatively, type and amount of analgesic agent administered postop eratively, age of the patient, performance of a vaginal versus an abdo minal hysterectomy, and the postoperative use of patient-controlled an algesia on the rate of postoperative urinary retention in these patien ts. RESULTS: After adjustment for confounding factors, only the use of patient-controlled analgesia (p=0.0001) and vaginal hysterectomy (p=0 .0003) were significantly related to postoperative urinary retention. Patients who used patient-controlled analgesia were 5.7 times (95 perc ent confidence interval, 2.6 to 12.4) more likely to have urinary rete ntion than those given an intramuscular agent. CONCLUSIONS: Urinary re tention after hysterectomy might be avoided by administering analgesic agents intramuscularly or inserting a suprapubic cystostomy catheter postoperatively, especially in patients who have undergone a vaginal p rocedure.