Urinary retention after endovascular treatment for aortic aneurysm: A single hospital experience

Objective After endovascular aortic repair (EVAR) for aortic aneurysm, some patients may develop urinary retention that may be vasogenic or neurogenic. This single-institution study investigated the characteristics of patients who developed urinary retention after EVAR for aortic aneurysm. Materials and Methods Patients with thoracic or abdominal aortic aneurysms and who underwent EVAR between November 2005 and October 2012 were reviewed. Those with post-operative urinary retention requiring urodynamic evaluation with filling cystometry (CMG) were identified. Their characteristics, surgical details, and urodynamic findings were collected for analysis. Results During the study period, 736 patients received endovascular treatment. Ten patients (nine males and one female; mean age at surgery, 71 ± 15.0 years) developed post-operative urinary retention, for an incidence rate of 1.36%. Two had co-morbid benign prostatic obstruction but all had aneurysm involving the thoracic aorta, with the largest mean aneurysm diameter at 64.8 ± 22.6 mm. All of the distal landing zones were above the celiac trunk and without occlusion of the blood supply to the urinary bladder. Seven patients had cerebrovascular complications or spinal cord ischemia. The CMG done within three months showed detrusor normoreflexia or over-activity in five, poor compliance of the urinary bladder in three, and acontractile detrusor in two patients. Those with acontractile detrusor had detrusor over-activity on follow-up CMG. Eight had successful decatheterization, while two with poor compliance of the urinary bladder needed long-term catheterization. The mean urethral catheter retention duration was 51.4 ± 33.1 days. Conclusions Urinary retention is a rare complication after EVAR for thoracic aortic aneurysm. Spinal cord ischemia or cerebrovascular complications may be contributory.