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

Abstract

INTRODUCTION Postoperative urinary retention requiring urethral catheterisation increases the risk of joint sepsis following arthroplasty. Spinal anaesthesia with opiate administration is used widely in lower limb arthroplasty. We sought to establish whether the choice of opiate agent had any effect on the incidence of postoperative retention and therefore the risk of joint sepsis. METHODS A total of 445 consecutive patients who underwent primary elective lower limb arthroplasty were reviewed retrospectively. Patients had general anaesthesia and femoral nerve block (GA+FNB), spinal anaesthesia and intrathecal fentanyl (SA+ITF) or spinal anaesthesia and intrathecal morphine (SA+ITM). RESULTS Urinary retention was observed in 14% of male and 2% of female patients with GA+FNB, 9% of male and 3% of female patients with SA+ITF, and 60% of male (p=0.0005) and 5% of female patients with SA+ITM. Men who experienced retention were older (68 vs 64 years, p=0.013) and had longer inpatient stays (6.7 vs 4.6 days, p=0.043). Fewer patients in the SA+ITM group required breakthrough analgesia (28% vs 58%, p=0.004). CONCUSIONS The use of ITM in men significantly increases the incidence of urinary retention requiring urethral catheterisation and subsequently increases the risk of deep joint sepsis. Its use should be rationalised against the intended benefits and alternatives sought where possible.

Buprenorphine–Induced Urinary Hesitancy is Common and Managed with Ease: A Retrospective Chart Review

“…Literature extensively discusses Post-operative urinary retention as a common complication of opioid regional anesthesia [10]. Urinary retention with epidural/intrathecal delivery of buprenorphine is also a known effect on the lower urinary tract [11].…”

History of Nocturia May Guide Urinary Catheterization for Total Joint Arthroplasty

“…18 There is more evidence that routine urethral catheterization is not needed in patients who have spinal anesthesia without opioids. 19,20 However, a recent multicenter study of patients undergoing fast-track total joint arthroplasty reported a 40% rate of urinary retention. 9 In addition, male sex and a history of benign prostatic hypertrophy are associated with an increased risk of retention.…”

Urinary Retention In Unilateral Total Knee Arthroplasty: Comparison Between Continuous Epidural Analgesia And Single-shot Femoral Nerve Block

“…1 Postoperative urinary retention can lead to significant morbidity, such as prosthetic infection and sepsis. 2 The spread of infection from the urinary tract to cause deep joint sepsis has been well documented and is more common following knee arthroplasty with a quoted incidence of 2.5% as compared with 0.64% post-hip arthroplasty. 1 Studies have shown increased incidence of urinary retention in patients using epidural when compared with nonepidural techniques.…”