Moxibustion in prevention of post-hemorrhoidectomy urinary retention of mixed hemorrhoid: A randomized clinical trial

Hemorrhoids is the most common disease in the anorectal department, and occurs at any age. Its incidence is increasing year by year and is as high as 49.1% in adults of China [1]. For severe hemorrhoids, surgery is the main therapy in clinical practice at present [2]. Urinary retention is the common complication after hemorrhoidectomy of mixed hemorrhoids with a incidence up to 32.8% [3]. Post-hemorrhoidectomy urinary retention (POUR) refers to urinary volume in the bladder more than 600 mL within 8 h after operation, manifested as dysuria and abdominal distention or inability to voluntarily or completely void after surgery and residual urine volume more than 100 mL [4]. POUR is mostly caused by anatomical features, anesthesia, surgical stimulation, compression of tamponade dressing, prostatic hyperplasia, mental and environmental factors, etc. [5] It is prone to induce urinary tract infection, even cause secondary reflux nephropathy and prolongs the hospital stay [6].

Currently, the measures for urinary retention include local hot compress, psychological counseling, listening to the sound of running water and postural urination. But the onset of effect is slow [7]. Urinary catheterization is an effective way, and yet, it easily damages the urethral mucosa and causes secondary urinary tract infection [8], with the incidence as high as 21.8% to 31.7%. Besides, after catheter removal, the patient may still be inability of voluntary or incomplete voiding, which induces the physical and psychological pains. The alpha-adrinephrine receptor blocker, represented by tamsulosin, is the common drug for preventing POUR [10]. Even so, its effect is not so satisfactory and the side effects may occur (vascular adverse event, e.g. postural hypotension) [11]. The anesthetics used during surgery may block the urethral and pelvic visceral nerves, causing weak contraction of the bladder muscle and spasm of the urethral sphincter, resulting in paruria [12]. Therefore, in clinic, anticholinergic drug, e.g. neostigmine, is often injected intramuscularly to stimulate the bladder, inhibit the urethral sphincter and promote urine voiding [5]. However, it still encounters the adverse events, e.g. cholinergic crisis [13]. Nowadays, acupuncture-moxibustion therapy in reference with meridian theory has been widely adopted in treatment of urinary retention and has achieved the favorable effect [14], [15], [16]. The study indicated that moxibustion may reduce the incidence of POUR and promote urination in anorectal and orthopedics departments [17]. However, it is a lack of clinical research of moxibustion for preventing urinary retention after hemorrhoidectomy of mixed hemorrhoids. The research reported in this paper focused on the effectiveness and safety of moxibustion on POUR of mixed hemorrhoids. The report is as follows.

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