Incidence and Predictive Risk Factors of Postoperative Urinary Retention After Primary Total Knee Arthroplasty

Bracey, Daniel N.; Hegde, Vishal; Pollet, Aviva K.; Johnson, Roseann M.; Miner, Todd

doi:10.1016/j.arth.2021.02.043

Cited by 17 publications

(24 citation statements)

References 22 publications

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“…Any volume above 600 ml is considered to be pathological. The cut-off used in included studies ranges from 200 to 400 ml after the voiding trial, and one prospective study 39 demonstrated that the threshold of 200 ml was useful in predicting the development of POUR (sensitivity, 0.80 and specificity, 79 per cent). Therefore, we do not assume the cut-off to be a significant source of heterogeneity as the range matches the physiological threshold of a sense of fullness and should be considered as a normal variation.…”

Section: Discussionmentioning

confidence: 99%

Impact of perioperative α1-antagonists on postoperative urinary retention in orthopaedic surgery: meta-analysis

et al. 2023

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Background Postoperative urinary retention (POUR) is a common complication following orthopaedic surgery. Previous studies attempted to establish the preventative role of α1-antagonist in POUR in the general surgical population; however, there is still no consensus regarding its use in orthopaedic surgery due to limited evidence. Methods Electronic databases of Cochrane Library, Embase, MEDLINE, and ClinicalTrials.gov were searched by two independent investigators from inception to 1 March 2022 to identify relevant randomized clinical trials. Two reviewers independently completed a critical appraisal of included trials by using the Cochrane Risk of Bias tool version 2.0 and extracted data from included articles. Risk of POUR was summarized as risk ratio (RR) with 95 per cent confidence intervals (c.i.). Mean difference (MD) was used for meta-analysis of continuous outcomes. Results Five randomized clinical trials involving 878 patients (α1-antagonist, 434; placebo, 444) undergoing hip/knee arthroplasty and spine surgeries were included. One study was assessed as high risk of bias from the randomization process and was excluded from the final meta-analysis. There was no difference in the risk of POUR between patients taking α1-antagonist and the placebo in arthroplasty (RR, 0.64; 95 per cent c.i., 0.36 to 1.14) and in spine surgeries (RR, 1.03; 95 per cent c.i., 0.69 to 1.55). There was no difference in length of stay (MD, −0.14 days; 95 per cent c.i., −0.33 to 0.05). Use of α1-antagonist was associated with a higher risk of adverse events (RR, 1.97; 95 per cent c.i., 1.27 to 3.06), with a composite of dizziness, light-headedness, fatigue, altered mental status, and syncope being the most commonly reported symptoms. Conclusion In patients undergoing spinal surgery and joint arthroplasty, routine administration of perioperative α1-antagonist does not decrease risk of POUR but does increase perioperative dizziness, light-headedness, and syncope.

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Section: Discussionmentioning

confidence: 99%

Impact of perioperative α1-antagonists on postoperative urinary retention in orthopaedic surgery: meta-analysis

et al. 2023

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“…11,12 Adequate pain control may be important to facilitate mobility and urination. 10 Future prospective studies on risk factors, preventive methods, and treatment strategies are needed to help establish more standardized protocols for POUR from its diagnosis to its treatment.…”

Section: Discussionmentioning

confidence: 99%

“…2,9,11,15,16 Other studies use alternative criteria, such as the occurrence of overflow incontinence or the presence of a postvoid residual volume exceeding 200 mL. 10,11 Finally, some do not use bladder scans, instead relying only on subjective patient reports or using an undefined duration postoperatively without spontaneous micturition. 16,17 Owing to an increased level of surveillance, studies using bladder scanning protocols would expectedly have higher incidences of POUR than those that rely on subjective patient reports.…”

Section: Incidencementioning

confidence: 99%

“…Although the duration of surgery is associated with an increased incidence of POUR, the published differences in surgical time range from 5 to 8 minutes, which is of questionable clinical significance. 4,10 Intraoperative placement of indwelling urinary catheters may contribute to the development of POUR. Three retrospective cohort studies demonstrated a positive association between indwelling catheter placement and POUR.…”

Section: Perioperative Risk Factorsmentioning

confidence: 99%

Section: Perioperative Risk Factorsmentioning

confidence: 99%

See 2 more Smart Citations

Postoperative Urinary Retention in Modern Rapid Recovery Total Joint Arthroplasty

Bracey

Barry

Khanuja

et al. 2022

J Am Acad Orthop Surg

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Postoperative urinary retention (POUR) is a disruptive complication after modern rapid recovery total joint arthroplasty. This review aims to synthesize the recent literature on POUR in the setting of total joint arthroplasty. The incidence of POUR ranges from 5.5% to 46.3%. The lack of a standardized definition of POUR accounts for some of this variability. Risk factors previously associated with the development of POUR include increasing age, male sex, benign prostatic hyperplasia, use of bupivacaine and intrathecal morphine in spinal anesthesia, glycopyrrolate, and volume of intraoperative intravenous fluid administered. Predictive scoring assessments, such as the International Prostate Symptom Score and a newer predictive nomogram, have not been adequately validated by high-quality studies. The treatment of POUR comprises either intermittent or indwelling urethral catheterization. Higher quality prospective studies are needed to allow for the standardization of all aspects of POUR from its diagnostic criteria to its treatment.

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A Retrospective Study of Anticholinergic Use and Later Mobilization as Risk Factors for Urinary Retention After Major Lower Extremity Joint Arthroplasty

Hejkal¹,

Ditoro²,

Thompson³

et al. 2023

The Journal of Arthroplasty

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Incidence and Predictive Risk Factors of Postoperative Urinary Retention After Primary Total Knee Arthroplasty

Cited by 17 publications

References 22 publications

Impact of perioperative α1-antagonists on postoperative urinary retention in orthopaedic surgery: meta-analysis

Impact of perioperative α1-antagonists on postoperative urinary retention in orthopaedic surgery: meta-analysis

Postoperative Urinary Retention in Modern Rapid Recovery Total Joint Arthroplasty

A Retrospective Study of Anticholinergic Use and Later Mobilization as Risk Factors for Urinary Retention After Major Lower Extremity Joint Arthroplasty

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