Urinary retention after total joint arthroplasty of hip and knee: Systematic review

Abstract

Purpose: Postoperative urinary retention (POUR) is a common complication after total joint arthroplasties (TJAs). The POUR is managed with urinary catheterization, which is associated with a risk of urinary tract infection and subsequent periprosthetic joint infection. The purpose of this review was to afford a comprehensive understanding of POUR and its management. Methods: We identified 15 original articles concerning POUR after TJA, which were published from January 2010 to February 2019. The diagnostic method, incidence, risk factors, and management of POUR of the 15 studies were reviewed. Results: The incidence of POUR was ranged from 4.1% to 46.3%. Ultrasound was used for the detection of POUR among the total of the 15 studies. The following factors of old age, male gender, benign prostatic hypertrophy, history of urinary retention, spinal/epidural anesthesia, excessive fluid administration, patient-controlled analgesia, the use of opiates, underlying comorbidities, and poor American Society of Anesthesiologists (ASA) grade were risk factors for POUR. Most of the studies did not use indwelling catheterization during surgery. The POUR patients were managed with intermittent catheterization. The most common volume criterion for bladder catheterization was 400 mL. In inevitable use of an indwelling catheter, it should be removed within 48 h. Conclusions: This review provided an up-to-date guide for the detection and management of POUR. Level of Evidence: Level III.

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

“…In addition, a recent systematic review of 6397 TJA patients concluded that indwelling catheters should only be used in cases of persistent POUR despite repeated intermittent catheterization. If an indwelling catheter was inevitably used, it should be removed within 48 hours [ 21 ]. While the evidence suggests that indwelling catheters pose significant risks to TJA patients, little has been done to stratify risk for urinary catheterization based on a patient’s preoperative profile.…”

Success Rate and Perioperative Complications of Lumbosacral Extradural Anaesthesia in Dogs Undergoing Total Hip Replacement: A Double-Centre Retrospective Study

“…Compared with other surgery, total arthroplasties carried a grater incidence of postoperative urinary retention in human patients, but the actual bladder capacity was estimated by ultrasound. 39 Using an ultrasound, postoperative urinary retention was detected in 5.9% of dogs after extradural anaesthesia. 11 Considering that dogs were cage rested for a variable amount of time, especially at centre A, and that only 3.2% of dogs needed postoperative intervention to empty the urinary bladder, it is possible that the bladder capacity was not completely full after 24 hours.…”

Patient characteristics and procedural variables are associated with length of stay and hospital cost among unilateral primary total hip arthroplasty patients: a single-center retrospective cohort study

“…Previous evidence against the routine use of catheterization aims to avoid the risk of urinary retention and infection [31][32][33]. Postoperative urinary retention is a common complication after the total joint arthroplasty and the incidence ranged from 4.1-46.3% [34]. Patients with a history of urinary retention and high volume of uid tend to experience urinary retention and infection postoperatively.…”