Effect of incision location and type of fistula on postoperative urinary retention after radical surgery for anal fistula: a retrospective analysis

Abstract

Abstract Background Postoperative urinary retention (POUR) refers to the postoperative symptom of bladder fullness without the ability to urinate autonomously. The etiology of POUR in proctology surgery remains unclear, and the underlying causes are multifactorial. The aim of this study was to determine the risk factors for POUR after radical surgery for anal fistula. Methods We retrospectively reviewed the clinical records of 511 patients who underwent radical surgery for anal fistula under general anesthesia at the China-Japan Friendship Hospital from August 2022 to December 2023. Risk factors for POUR were determined using binary logistic regression analyses. Results 57 patients (11.2%) experienced urinary retention within 48 hours after surgery, while the majority of whom were male (84.4%). Multivariate logistic stepwise regression revealed that a history of urological disease (OR = 6.048; P < 0.001), incisions at position 1 (OR = 2.228; P = 0.046), the presence of high anal fistula (OR = 4.768; P < 0.001), a VAS score ≥ 7 (OR = 2.805; P = 0.010), and a GAD-7 score ≥ 5 (OR = 2.405; P = 0.024) were independent risk factors for POUR after radical surgery for anal fistula. Conclusion POUR is a common complication following radical surgery for anal fistula. Patients with urological disease or high anal fistula or incisions at position 1 are more likely to develop POUR. Surgeons should pay more attention to the surgical techniques of fistulas in the anterior rectum. Better postoperative pain and anxiety management strategies should be provided to reduce the incidence of POUR and avoid irreversible damage caused by persistent bladder overdistension.