Post-operative Urinary Dysfunction Following Shoulder Surgery: Rates and Risk Factors

Document Type : RESEARCH PAPER


1 The Carrell Clinic, Dallas, TX, USA

2 Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA, USA

3 University of Miami, Miller School of Medicine, Miami, FL, USA

4 IHA Orthopaedic Surgery Associates at St. Joe’s Ann Arbor, Ypsilanti, MI, USA


Background: Post-operative urinary retention (POUR) and dysfunction are recognized complications following
orthopaedic surgery. Recent literature has focused on urinary retention and its associated complications following hip
and knee reconstruction and lower extremity surgery. There is a paucity of literature focusing on POUR and shoulder
surgery. The purpose of this study is to describe the rates of urinary dysfunction in patients undergoing shoulder surgery
as well as the associated risk factors.
Methods: This was a single institution, prospective cohort study. Eligibility criteria included patients older than 50
years of age undergoing open or arthroscopic shoulder surgery. The primary outcome was the American Urological
Association (AUA) symptom score (7 questions total scored 0-5, total 35 points max) administered before and after
surgery. Higher scores reflect worse urinary dysfunction. Intra-operative data such as type of surgery, type of anesthesia,
use of anticholinergics, peripheral nerve block, length of case, and amount of intravenous fluids were collected.
Results: Of 194 patients, the mean age was 61.4 years (Standard Deviation (S.D.) = 13.0)) and the average BMI was
29.2 (S.D. = 5.6). The sample was 35.6% female. Overall, 46.4% reported worse AUA scores post-operatively within the
first 3 to 5 days, including 4.1% of which were clinically defined as “moderately worse” (>5 point worse) or “much worse”
(>11 points worse). Worse preoperative AUA scores correlated with worse postop AUA score on linear regression
analysis (r=0.883, P<0.0001). Males with a history of BPH showed a statistically significant positive association with
worsening urinary dysfunction postoperatively (P=0.039). Four patients (2.1%) required postoperative catheterization.
A significantly higher percentage of patients with preoperative AUA scores of ≥11 experienced worsening of urinary
function post-operatively (P=0.04).
Conclusion: Worsening of urinary function following shoulder surgery is common. The AUA score may be used to
identify at-risk patients and to track changes in urinary function post-operatively. Men with a diagnosis of BPH are at
particularly high risk. Further investigation is needed to elucidate the impact of urinary dysfunction on patient outcomes,
satisfaction, and cost as well as the role of prophylactic medications.
Level of evidence: II


Main Subjects

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