Risk Factors for Postoperative Urinary Retention in Men Undergoing Total Hip Arthroplasty

Abstract

Postoperative urinary retention is a common complication after major orthopedic procedures of the lower limb. In total hip arthroplasty and total knee arthroplasty, the incidence ranges from 7% to 84%. In this study, the incidence and risk factors for postoperative urinary retention were described in a cohort of 376 men undergoing total hip arthroplasty. Postoperative urinary retention was defined as the inability to void after surgery for which single or indwelling catheterization was performed. Risk factors were identified using multivariate regression analysis. Following total hip arthroplasty, 150 (39.9%) of the 376 men developed urinary retention. Patient-controlled analgesia (odds ratio, 4.10; 95% confidence interval, 1.79-9.40), use of spinal anesthesia (odds ratio, 1.79; 95% confidence interval, 1.07-2.99), and age 70 years or older (odds ratio, 1.77; 95% confidence interval, 1.06-2.95) were independent risk factors for urinary retention. Potential risk factors that were not confirmed included body mass index, American Society of Anesthesiologists physical status (Class I-III), hypertension, diabetes mellitus, prostate pathology, smoking, average pain during the first 24 hours after surgery, and length of surgery. Two of the 150 patients with urinary retention (1.3%) for which a catheter has been inserted developed a urinary tract infection vs none of the patients without urinary retention. The risk of urinary retention after total hip arthroplasty is increased in men older than 70 years, those receiving spinal anesthesia, and those with patient-controlled analgesia postoperatively.

The use of bladder volume measurement assessed by ultrasound in predicting postoperative urinary retention

“…Authors also revealed age of 70 years or older, spinal anesthesia, and postoperative patient -controlled analgesia were independent risk factors for POUR [9]. Higher incidence of POUR when compared with our study might be related to difference in surgical procedure performed or use of morphine sulfate during postoperative period, rather than paracetamol.…”

Discontinuation of peri‐operative gentamicin use for indwelling urinary catheter manipulation in orthopaedic surgery

“…Other strategies to reduce the risk of IDC‐related UTI in the peri‐operative setting include intermittent or no catheterization, early mobilization (that shortens the period when the IDC needs to remain in place), training for insertion techniques, good IDC care and consideration of IDC materials . Male patients receiving epidural anaesthesia may be at greater risk of urinary retention in the setting of orthopaedic surgery …”

“…33 Male patients receiving epidural anaesthesia may be at greater risk of urinary retention in the setting of orthopaedic surgery. [34][35][36] There were several limitations to our study. These included confounding factors that may influence SSI rates (skin preparation, surgical technique and patient comorbidities) and the significantly larger proportion of male patients in the post-intervention sample (probably resulting from variation in data collection methods).…”

Enhanced recovery after surgery (ERAS) pathway for primary hip and knee arthroplasty: study protocol for a randomized controlled trial

“…Regional anesthesia is recommended for ERAS because it provides reliable analgesia and little disturbance on hemodynamics in published literatures [2,3,4,6]. However, for patients undergoing THA and TKA, spinal anesthesia is frequently associated with prolonged indwelling urinary catheter [7], and furthermore, the peripheral nerve block may weaken the lower limb muscle strength, leading to delayed mobilization [8].…”