What is this study about? This study is testing whether a common medication called dexamethasone, given through a vein (IV) before surgery, can help prevent a problem called postoperative urinary retention (POUR). POUR means having trouble urinating after surgery, which can cause discomfort and sometimes requires using a catheter.

Who can join the study? The study includes adult People who are having surgery with spinal anesthesia at Al-Makassed Hospital. People who have certain medical conditions, use steroids regularly, or need a catheter during surgery cannot join.

What will happen in the study?

Participants will be randomly assigned to one of two groups:

• One group will get 8 mg of IV dexamethasone before surgery.
• The other group will get a saltwater (placebo) injection. Neither the participants nor the doctors will know which treatment they receive.

After surgery, the researchers will check how soon each participant can urinate and whether they need a catheter.

Why is this study important? POUR can slow recovery and cause complications. Dexamethasone is already used for other reasons like nausea and swelling. This study will help find out if it also lowers the risk of POUR in people getting spinal anesthesia.

Postoperative urinary retention (POUR) is a common complication following spinal anesthesia, affecting patient comfort, recovery, and sometimes requiring catheterization. While dexamethasone is routinely used to prevent nausea and inflammation in surgical patients, its potential role in preventing POUR has not been fully explored, especially in the context of spinal anesthesia.

This study is a prospective, randomized, double-blind, placebo-controlled clinical trial conducted at Al-Makassed Hospital. It aims to evaluate whether a single preoperative intravenous dose of 8 mg dexamethasone reduces the incidence of POUR in adult patients undergoing elective surgery under spinal anesthesia.

Eligible participants are randomized into two equal groups using block randomization. One group receives 8 mg of IV dexamethasone, and the other receives a placebo (0.9% saline). Both patients and assessors are blinded to group assignment. Data will be collected on age, BMI, comorbidities (including history of BPH or prior POUR), current anticholinergic drug use, anesthetic agent and dose, which level of spinal anesthesia (e.g. L3-L4), type of surgery, IV fluid volume, and duration of operation.

The primary outcome is the incidence of POUR, defined as failure to void within 6 hours after surgery and requiring catheterization. Secondary outcomes include time to first void and the overall need for urinary catheterization. Safety data will also be recorded, and any adverse events related to dexamethasone will be reported.

The study has been approved by the Al-Quds University Research Ethics Committee. All participants will provide informed consent prior to enrollment.

Inclusion Criteria:

• Adult patients at Al-Makassed Hospital undergoing spinal anesthesia for surgery

Exclusion Criteria:

• Chronic steroid use
• Individuals who should not be administered dexamethasone
• Have a history of urological issues or procedures
• Have neurological disorders
• Using an intraoperative Foley's catheter
• Operations for possible nerve damage

Individual participant data (IPD) will not be shared because this study is conducted at a single center with limited infrastructure for data sharing. Additionally, the current ethical approval and informed consent do not include provisions for sharing de-identified participant-level data with external researchers.

This is a double-blinded study. Both participants and outcome assessors are unaware of the group assignments. A non-participating physician performed the randomization using a computer-generated block randomization list. Study drugs (dexamethasone or placebo) are prepared in identical syringes labeled with participant codes only, ensuring that care providers and investigators remain blinded during the intervention and follow-up period.