Analysis of Risks and Consequences of Postcatheter Urinary Retention After Primary Total Hip and Knee Arthroplasty

Abstract

Background: Postoperative urinary retention (POUR) in total joint arthroplasty (TJA) is common. However, risk factors for POUR and its consequences, specifically on postoperative renal function, have not been well defined. Methods: We performed a review of prospectively collected data on consecutive adult patients undergoing primary total joint arthroplasty from August 2014 to December 2015. Catheters were placed preoperatively and removed on the first or second postoperative day. The exclusion criterion was traumatic catheter insertion or the presence of fracture or neoplasm. Univariate and multiple logistic regression identified associations with POUR and its invasive therapies. Subgroup analysis of renal function by incidence of preoperative bladder outlet obstruction (BOO) and POUR was performed with nonparametric testing. Results: A total of 591 operations met inclusion criteria. The incidence of POUR was 6.4% and was directly related to a positive history of BOO (odds ratio [OR]: 4.15) and increased the duration of urinary catheterization (OR: 1.04). These factors, in addition to preoperative incontinence (OR: 8.36, 28.69) and lengthier hospitalizations (OR: 1.37, 1.30), were significantly associated with intermittent straight catheterization and reinsertion of an indwelling catheter to treat POUR. Serum creatinine increased with combined preoperative BOO and POUR (þ0.22 mg/dL) but was preserved in others (þ0.02-0.04 mg/dL) (P < 0.01). Conclusions: Preoperative BOO and longer catheterization increased the risk of POUR and were associated with the use of invasive modalities to treat POUR. POUR was associated with a longer hospitalization and impaired renal function in those with preoperative BOO; therefore, renal function should be monitored closely and nephrotoxic medications used cautiously when using urinary catheters in this patient population.

Routine Indwelling Urinary Catheterization Is Not Necessary During Total Hip Arthroplasty Performed Under Spinal Anesthesia

“…Previously identified risk factors for POUR following total joint arthroplasty include use of spinal anesthesia, use of postoperative patient-controlled analgesia, increasing age, increasing intraoperative fluid administration, increasing time of indwelling catheterization, and history of urinary retention [ 5 , 6 , 10 , 18 ]. Lawrie et al.…”

“…While it is a common complication following arthroplasty procedures, postoperative urinary retention itself remains poorly defined. Prior studies have used thresholds ranging from 300 to 800 milliliters on postoperative ultrasound bladder scans as diagnostic criteria for POUR and as an indication for catheterization [ 3 , 10 , 19 ]. This lack of consistency complicates interpretation of the literature.…”

“…Conversely, spinal anesthesia may have benefits with respect to an overall complication rate and length of stay when compared to general anesthesia for patients undergoing THA, which has led to a recent increase in the use of neuraxial blockade [ [7] , [8] , [9] ]. Urinary retention is not a benign complication following primary joint arthroplasty, however, as it has been associated with urinary tract infection (UTI), delayed mobilization, prolonged hospitalization, and increased readmission [ 1 , 10 ]. Furthermore, UTI has been has been identified as a source of bacteremia and associated risk factor for periprosthetic joint infection [ 2 , 11 , 12 ].…”

“…Alternatively, other surgeons elect to avoid routine catherization in favor of close monitoring for development of retention, with intermittent catheterization used on an as-needed basis. While both routine indwelling catheterization and as-needed straight catherization represent viable options to prevent excessive bladder distension and long-term detrusor injury, each technique has had variable reported effects on the rate of POUR and UTI [ 2 , 3 , 10 ]. The purpose of this study was to examine the effect of routine indwelling urinary catheterization following primary THA performed under spinal anesthesia on the incidence of POUR and other urinary complications.…”

Same-Day Outpatient Lower-Extremity Joint Replacement

“…A recent singlecenter observational analysis correlated spinal anesthesia with a higher incidence of POUR 82 . Other series indicate that routine use of urinary catheters and excessive intravenous (IV) fluid or albumin administration have been tied to a higher incidence of POUR in ASC or outpatient hospital settings 81,[83][84][85] . Several perioperative and patientspecific factors have been correlated with a risk of POUR, including male sex, a history of POUR, the use of certain inhaled and IV anesthetics or induction agents, and the addition of an opioid to the intrathecal anesthetic 51 .…”