Does BPH symptom scoring correlate with difficulty urinating after hernia surgery?

Jacob Hebert, MD, Shoichiro A Tanaka, MD, William S Richardson, MD. Ochsner Clinic

Introduction: Difficulty urinating after hernia surgery effects many patients and can lead to bladder catheterization, increasing length of hospital stay and patient dissatisfaction.  Our aim was to identify patients at risk so that we could consider prophylactic intervention.

Methods: This was a retrospective chart review.  Adult male patients undergoing open or laparoscopic inguinal hernia repair were given the American Urologic Association BPH Symptom Score Index Questionnaire (Likert scale 0-5 for emptying, frequency, intermittency, urgency, weak stream, straining, nocturia and total score).  The scores were correlated with length of postoperative stay calculated from the time of OR finish until discharge from the hospital.  Urinary interventions were recorded.

Results: 27 patients filled out the questionnaire.  All patients were operated on in2014 and 15.  Average age was 62 (range 34-85).  There were 15 laparoscopic bilateral, 4 laparoscopic unilateral, 4 open unilateral and 2 laparoscopic repairs. 2 repairs were done with umbilical hernia repair.   Average length of postoperative stay was 229 minutes (range 106-748).  9 Patients stayed over 4 hours and 4 patients stayed under 2 hours.  The vast majority of patients staying over 4 hours was for difficulty urinating.   No patients in this group were catheterized and one had a bladder scan.  There was a negative trend of correlation between age and length of stay but this was not significant.  The average total BPH score was 8.8 (range 0-25).  There was no correlation with individual or total preoperative symptom scores and postoperative length of stay.  The closest was intermittency with a p value of 0.479.

Conclusion: Although BPH symptoms scores are easy to obtain they do not correlate well enough to use as a means of predicting postoperative urinary difficulty or for intervention.  Age also does not seem to be a reasonable means of identifying patients at risk.