Urinary retention and the role of indwelling catheterization following total knee arthroplasty

Abstract

Introduction:We aimed to investigate the rate of urinary retention after knee arthroplasty, the various factors involved in predicting those at risk for retention and to assess the impact of retention and catheterization on joint sepsis. Materials and Methods: A retrospective review was conducted of all available case notes of patients undergoing total knee arthroplasty in a consecutive 2-year period (2000)(2001)(2002). Adequate data was available for 142 patients. Results: 142 patients underwent total knee arthroplasty. 19 patients were catheterized preoperatively for monitoring urine output. 123 patients were not catheterized. Urinary retention occurred in 19.7% (28/142). The mean day of catheterization for retention was 0.66. The mean duration of catheterization in patients developing retention was 3.58 days and was 3 days in the patients catheterized pre -or perioperatively. Deep joint sepsis occurred in 2.1% (3/142) -only one had been catheterized and that was preoperatively. No case of infection had urinary retention or had a symptomatic urinary tract infection. The only factors predicting those at significant risk of retention following knee arthroplasty was a past medical history of urinary retention (p = 0.049) and postoperative morphine requirement (p = 0.035). No patients required urological surgical intervention at mean follow up of 1.97 years. Conclusions: This study supports the use of indwelling urinary catheterization for patients developing urinary retention after total knee arthroplasty.

Predicting postoperative urinary retention after lower limb arthroplasty

“…Several other factors have been indicated for giving an increased incidence of POUR such as increased prostate specific antigen, previous history of POUR 17 and a peak urinary flow of <17ml/s 18 . Other factors or situations tend to necessitate catheterisation, eg extensive revision surgery and bilateral joint replacements.…”

Predictors of Successful Trial without Catheter for Postoperative Urinary Retention Following Non-Urological Surgery

“…Some studies have shown that gender is not correlated significantly with the development of POUR [5,10,11]. Also, Tammela et al [14] suggested that there was no significant difference in frequencies of persistent micturition difficulty after the first catheterization for POUR between male and female patients.…”

The incidence of postoperative urinary retention in patients undergoing elective hip and knee arthroplasty

“…1 Retention is commonly treated with urethral catheterisation, which can itself induce bacteraemia and further increase the risk of deep joint sepsis. [1][2][3] Previous studies report an incidence of deep sepsis following primary total hip replacement (THR) of <2% 4 rising to as much as 6.2% 1,5 with postoperative urethral catheterisation.…”

“…As a consequence, a number of studies have tried to better define the risk factors for retention by addressing the surgical factors 5,[8][9][10][11] and individual patient factors 5,8,10,12 associated with retention. To date, there is compelling evidence that male sex, increasing age and epidural opioids pose independent risk factors for the development of retention.…”