Indwelling Urinary Catheter for Total Joint Arthroplasty Using Epidural Anesthesia

Scotting, Oliver; North, W. Trevor; Chen, Chaoyang; Charters, Michael A.

doi:10.1016/j.arth.2019.05.047

Cited by 7 publications

(13 citation statements)

References 21 publications

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“…10 Neuraxial anesthesia (intrathecal, epidural, or spinal) was used on all 335 consecutive patients in a retrospective analysis. 11 All patients had TJA; 103 had catheter placement and 232 did not. 11 The authors concluded that neuraxial anesthesia presented no increased risk for postoperative urological complications without the insertion of an indwelling urinary catheter, unless patients had preexisting BPH, renal failure, male sex, or advanced age, which would predispose them to an increased risk for POUR and possible need for intermittent versus indwelling catheterization.…”

Section: Resultsmentioning

confidence: 99%

“…Neuraxial anesthesia (intrathecal, epidural, or spinal) was used on all 335 consecutive patients in a retrospective analysis 11. All patients had TJA; 103 had catheter placement and 232 did not 11.…”

Section: Resultsmentioning

confidence: 99%

“…9 Two studies identified neuraxial anesthesia in TJA; nine studies did not specify the type of anesthesia in TJA. 2,3,[5][6][7][8][10][11][12][13][14] The research by Zhang and colleagues is confounding in that they contended that urinary catheterization did not place patients at increased risk for POUR or CAUTI, yet noted that unnecessary catheterization could be avoided in many cases and could result in early mobilization. 13 This research was referenced because it outlined the previous lack of consensus regarding the appropriate use of urinary catheters in TJA.…”

Section: Limitationsmentioning

confidence: 99%

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Should urinary catheters be avoided in patients with total joint arthroplasty?

Baldwin

2023

Jaapa

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Patients undergoing total joint arthroplasty typically have indwelling urinary catheters placed preoperatively to decompress the bladder, assess urinary output, and prevent postoperative urinary retention. However, catheterization is associated with several complications and increased hospital length of stay, and research supports eliminating routine placement of urinary catheters in most patients undergoing elective joint arthroplasty and certain general surgeries lasting no more than 2 hours.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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Should urinary catheters be avoided in patients with total joint arthroplasty?

Baldwin

2023

Jaapa

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“…The reason for the varied incidence may be that the definitions of POUR were quite different among studies. Some studies used bladder scan to assess the volume of urine in the bladder, and POUR was diagnosed if urine volume exceeds 400 ml ( Scotting et al, 2019 ; Bracey et al, 2021 ). Some studies relied on the subjective patient reports and the clinical symptoms, such as suprapubic discomfort, distention symptoms and urinary incontinence, to define POUR ( Santini et al, 2019 ; Abdul-Muhsin et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Prophylactic doxazosin reduces urinary retention and promotes recovery after total joint arthroplasty: A randomized controlled trial

et al. 2023

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Background: Postoperative urinary retention (POUR) is a common and disruptive complication following total joint arthroplasty (TJA). The aim of this study is to investigate whether doxazosin can decrease the incidence of POUR and promote recovery under the setting of modern enhanced recovery after TJA.Methods: In this randomized placebo-controlled trial, patients over 35 years of age undergoing primary unilateral TJA were recruited. Patients received doxazosin (4 mg once) or placebo 2 h before surgery. The primary outcome of interest was the development of POUR, which was diagnosed when patients with a urine volume over 400 ml or overflow incontinence. Postoperative recovery was assessed in terms of hospital length of stay after surgery, daily ambulation distance, visual analogue scale (VAS) pain score and opioid consumption.Results: A total of 170 male patients were equally randomized into Doxazosin group (mean age 54.2 ± 13.7 years, range 36–88 years) and Placebo group (mean age 54.6 ± 13.9 years, range 38–81 years). The POUR rate was significant lower in Doxazosin group (17.6%) than in Placebo group (36.5%) (p = .006). The mean LOS in the Doxazosin group was 3.1 ± 1.1 days compared to 3.6 ± 1.7 days in the Placebo group (p = .030). Doxazosin group had a longer daily mobilization distance than Placebo group on postoperative day 1 (26.8 ± 11.1 vs. 22.8 ± 9.7; p = .015). Postoperative pain assessed by VAS score and opioid usage was comparable between two groups.Conclusion: Our results support the routine use of prophylactic doxazosin in male patients to decrease POUR rate and promote postoperative recovery under the setting of modern enhanced recovery after TJA.

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“…4,10,13,14 Some studies do not use a predefined duration postoperatively and instead rely on subjective patient reports of suprapubic discomfort from bladder distension to perform bladder scans, followed by urethral catheterization if the volume exceeds 200 to 600 mL. 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.…”

Section: Incidencementioning

confidence: 99%

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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Indwelling Urinary Catheter for Total Joint Arthroplasty Using Epidural Anesthesia

Cited by 7 publications

References 21 publications

Should urinary catheters be avoided in patients with total joint arthroplasty?

Should urinary catheters be avoided in patients with total joint arthroplasty?

Prophylactic doxazosin reduces urinary retention and promotes recovery after total joint arthroplasty: A randomized controlled trial

Postoperative Urinary Retention in Modern Rapid Recovery Total Joint Arthroplasty

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