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

Background: Post-operative urinary retention (POUR) and dysfunction are recognized complications followingorthopaedic surgery. Recent literature has focused on urinary retention and its associated complications following hipand knee reconstruction and lower extremity surgery. There is a paucity of literature focusing on POUR and shouldersurgery. The purpose of this study is to describe the rates of urinary dysfunction in patients undergoing shoulder surgeryas well as the associated risk factors.Methods: This was a single institution, prospective cohort study. Eligibility criteria included patients older than 50years of age undergoing open or arthroscopic shoulder surgery. The primary outcome was the American UrologicalAssociation (AUA) symptom score (7 questions total scored 0-5, total 35 points max) administered before and aftersurgery. 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 was29.2 (S.D. = 5.6). The sample was 35.6% female. Overall, 46.4% reported worse AUA scores post-operatively within thefirst 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 regressionanalysis (r=0.883, P 0.0001). Males with a history of BPH showed a statistically significant positive association withworsening 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 urinaryfunction post-operatively (P=0.04).Conclusion: Worsening of urinary function following shoulder surgery is common. The AUA score may be used toidentify at-risk patients and to track changes in urinary function post-operatively. Men with a diagnosis of BPH are atparticularly 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