Preoperative Factors to Assess Risk for Postoperative Urinary Retention in Total Joint Arthroplasty: A Retrospective Analysis

Abstract

Background Postoperative urinary retention (POUR) is a significant problem in total joint arthroplasty (TJA). Although risk factors for POUR have been well documented, they are ubiquitous in an aging total joint population, which makes risk stratification difficult. The purpose of this study was to determine if a high preoperative post-void bladder scan identifies patients at risk for POUR. Methods A retrospective analysis was conducted on all TJAs performed at a high-volume orthopedic center between December 2019 and February 2020. A total of 585 elective TJA patients received post-void bladder scans before surgery. Bladder scan volumes were correlated with catheterization via Chi-squared tests. Results A high post-void residual volume (PVRV > 50 ml) was associated with an increased risk of catheterization (23% vs 34%, chi-squared statistic = 6.2638, P value = .013), as was intravenous fluid volume (>1000 ml in knee, >2000 ml in hip). Catheterization rates were higher among total knee arthroplasty patients younger than 60 years (37% vs 24%, chi-squared statistic = 4.284, P value = .0385) and total hip arthroplasty (THA) patients older than 65 years (30% vs 18%, chi-squared statistic = 3.292, P value = .0695). Multiple risk factors were additive. Conclusions Higher PVRV and intravenous fluids were independently associated with catheterization after TJA. Younger age was associated with greater risk in total knee arthroplasty, while older age increased risk in THA. We propose that a preoperative bladder scan to detect a high PVRV may provide clinical utility to identify patients likely to develop POUR.

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

“…Notably, these findings depart from the principal conclusions of Magaldi et al. [ 12 ], who contend that PrePVR >50 mL is a predictor of POUR. Some methodological differences may account for this disagreement.…”

“…The results of this study highlight that the use of bladder scanning preoperatively with a PrePVR >50 as a threshold may not be an effective screening modality for the risk of POUR. This is contrary to prior evidence suggesting that PrePVR of greater than 50 mL may serve as a useful screening tool [ 12 ]. Notably, these findings depart from the principal conclusions of Magaldi et al.…”

Preoperative Bladder Scanning Can Predict Postoperative Urinary Retention Following Total Joint Arthroplasty

“…Furthermore, in this study, we found that the preoperative use of the AUA symptom survey, widely used to detect symptoms of prostate enlargement or urinary problems, was not useful for predicting POUR in a TJA population. Although our study found no significant association with sex or age, younger patients undergoing TKA trended toward developing POUR, a finding also confirmed by our previous retrospective study 9 . With the increasing prevalence of outpatient TJA, this study addresses a potential impediment to discharge.…”

“…Interestingly, Scholten et al reported that preoperative PVRV was associated with POUR following TJA but recommended against monitoring because it seemed to identify pre-existing voiding issues 14 . In a recent retrospective study that excluded patients with a history of urinary retention and bladder symptoms, we found increased catheterization with a preoperative PVRV of >50 mL in patients undergoing TJA 9 . Despite the evidence pointing to a clear association, there is no consensus that POUR is predictable at a specific residual volume.…”

“…Other authors have identified that TJA itself was a risk factor for POUR, with rates 20-times greater than in the general surgery population 2-4 . In a recent retrospective cohort study at our institution, we found that the incidence of POUR was 35% in an adult TJA population with no history of urinary problems 9 .…”