Predictive Risk Factors for Urinary Retention After Hemorrhoid Surgery

Abstract Background: Although urinary retention (UR) is one of the most frequent complications after proctological surgery, most studies identifying risk factors were conducted before the development of current good practice guidelines. Objective: This study aimed to update the list of risk factors for UR occurring within 14 days after hemorrhoid surgery and to develop a predictive algorithm. Design: A retrospective observational study based on computerized medical records. Patient and Methods: All patients who underwent hemorrhoid surgery between 2018 and 2023 in a single hospital in Paris. Main Outcome Measures: All occurrences of UR within 14 days after surgery. Sample Size: A total of 4233 interventions were included. Results: The frequency of UR was 4.4% (n = 185). Among these, 674 (16%) were minimally invasive procedures. Spinal anesthesia was used in 513 operations (12.5%), and 2605 operations (63.7%) were performed under pudendal nerve block. The following risk factors were identified: male sex (odds ratio [OR]: 1.6; 95% confidence interval [CI] [1.0–2.5]); high prostatic risk, defined as benign prostatic hyperplasia or a history of prostate surgery (OR: 4.3; 95% CI [2.1–8.8]); and the use of certain techniques—tripedicular hemorrhoidectomy (OR: 4.0; 95% CI [1.9–8.5]), Tripedicular hemorrhoidectomy with fissulectomy (OR: 3.4; 95% CI [1.2–9.2]), and ligation of the hemorrhoidal arteries under Doppler control with mucopexy (OR: 4.5; 95% CI [1.9–10.7]). The perioperative administration of nonsteroidal anti-inflammatory drugs (NSAIDs) was protective (OR: 0.6; 95% CI [0.4–0.9]). The use of a pudendal nerve block or spinal anesthesia had no effect on the risk of UR. The predictive model yielded an area under the curve of 0.71 (95%CI: 0.63–0.80). Conclusion: Certain surgical techniques were associated with a higher risk of UR. Conversely, the perioperative administration of NSAIDs was protective. The type of anesthesia did not affect the risk of UR. Limitations: Single-center, retrospective design. Conflict of interest: VdP reports conflicts of interest with A. Legrand, Biolitec, FCare Systems, and THD lab. The other authors declare no conflicts of interest.