History of Nocturia May Guide Urinary Catheterization for Total Joint Arthroplasty

Abstract

Urinary tract infection is a common complication after total knee arthroplasty (TKA) and can be related to urethral catheterization. This study attempted to determine whether nocturia could be used as an indicator of risk for postoperative urinary retention to limit the need for prophylactic catheterization in men undergoing TKA. A retrospective study was performed in a consecutive series of men undergoing TKA at a single Veterans Affairs medical center. Patients reporting 0 episodes or 1 episode of nocturia per night were not catheterized prophylactically, and patients reporting 2 or more episodes of nocturia each night were catheterized preoperatively. Of 100 consecutive patients, 51 reported no more than 1 episode of nocturia and did not undergo preoperative catheterization. Of these patients, 10 required 1 postoperative straight catheterization for urinary retention. In the 49 patients who were catheterized prophylactically, all catheters were removed on postoperative day 1. Only 1 of these patients required reinsertion of a catheter. No patient in either group was discharged with a catheter or had a urinary tract infection. Previously, the authors' standard protocol was to use a prophylactic urinary catheter for all men after TKA. In this 100-patient cohort, with this new protocol, 41 patients were not catheterized at all and 10 patients had only 1 straight catheterization. In this study, the frequency of nocturia in men undergoing TKA was an effective screening tool that safely reduced the need for an indwelling catheter in 51% of patients. [Orthopedics. 2016; 39(4):e749-e752.].

Optimised fast‐track protocols in total knee arthroplasty determine shorter hospitalisation time and lower perioperative/postoperative complications

“…A retrospective study [34] which included 100 male patients who underwent primary TKA with indwelling urinary catheters concluded that the history of nocturia could be an effective screening tool for the safe elimination of indwelling catheterisation prior surgery.…”

“…Several risk factors have been defined for this complication, such as patient age, male gender and history of urologic obstructive disease. Moreover, the usage of a urinary catheter is linked to an increased risk of UTIs and prosthetic joint infections [5,6,34].…”

Preoperative Postvoid Residual Is Not Predictive of Postoperative Urinary Retention in Primary Total Joint Arthroplasty Patients

“…Previous studies have identified increasing patient age as a significant risk factor for the onset of POUR [ 12 , 14 , 15 , [22] , [23] , [24] ], and male sex is equally well-described as a predisposing factor [ 12 , 14 , 15 , 25 ]. Other commonly identified risk factors include administration of high volumes of fluid intraoperatively and postoperatively [ [12] , [13] , [14] , 23 , 26 ], previous history of urologic disease such as benign prostatic hyperplasia or weak urinary stream [ [13] , [14] , [15] , [24] , [25] , [26] , [27] , [28] , [29] ], intraoperative catheter placement [ 23 ], the use of opioid analgesics during or after surgery (especially patient-controlled analgesia) [ 12 , 14 , 25 , 30 , 31 ], spinal or epidural anesthesia [ [11] , [12] , [13] , [14] ], poor ASA grade [ 14 ], and other medical comorbidities such as diabetes, renal disease, or even psychiatric disease [ 14 , 15 ]. Most of these factors are consistent with what is expected physiologically.…”

Increased Duration of Total Hip and Total Knee Arthroplasty Surgery Increases the Risk of Post-Operative Urinary Retention: A Retrospective Cohort Study

“…The risk of urinary tract infection following bladder catheterization post-arthroplasty is a significant concern, given its status as a well-recognized post-operative complication [ 29 , 30 ]. Hematogenous spread from the urinary tract poses the potential threat of infecting the prosthetic joint or causing systemic dissemination, leading to severe complications, like sepsis [ 31 ].…”