Analysis of Risks and Consequences of Postcatheter Urinary Retention After Primary Total Hip and Knee Arthroplasty

Joshua A. Shapiro, MD; Paul M. Alvarez, MD; Anthony V. Paterno, MS; Christopher W. Olcott, MD; Daniel J. Del Gaizo, MD

Arthroplasty Today (Dec 2020)

Analysis of Risks and Consequences of Postcatheter Urinary Retention After Primary Total Hip and Knee Arthroplasty

Joshua A. Shapiro, MD,
Paul M. Alvarez, MD,
Anthony V. Paterno, MS,
Christopher W. Olcott, MD,
Daniel J. Del Gaizo, MD

Affiliations

Joshua A. Shapiro, MD: Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Paul M. Alvarez, MD: School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Corresponding author. 376 West 10th Avenue, 725 Prior Hall, Columbus, OH 43210-1228, USA. Tel.: +1 786 253 3491.
Anthony V. Paterno, MS: School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Christopher W. Olcott, MD: Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Daniel J. Del Gaizo, MD: Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

Journal volume & issue: Vol. 6, no. 4
pp. 888 – 893

Abstract

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Background: Postoperative urinary retention (POUR) in total joint arthroplasty (TJA) is common. However, risk factors for POUR and its consequences, specifically on postoperative renal function, have not been well defined. Methods: We performed a review of prospectively collected data on consecutive adult patients undergoing primary total joint arthroplasty from August 2014 to December 2015. Catheters were placed preoperatively and removed on the first or second postoperative day. The exclusion criterion was traumatic catheter insertion or the presence of fracture or neoplasm. Univariate and multiple logistic regression identified associations with POUR and its invasive therapies. Subgroup analysis of renal function by incidence of preoperative bladder outlet obstruction (BOO) and POUR was performed with nonparametric testing. Results: A total of 591 operations met inclusion criteria. The incidence of POUR was 6.4% and was directly related to a positive history of BOO (odds ratio [OR]: 4.15) and increased the duration of urinary catheterization (OR: 1.04). These factors, in addition to preoperative incontinence (OR: 8.36, 28.69) and lengthier hospitalizations (OR: 1.37, 1.30), were significantly associated with intermittent straight catheterization and reinsertion of an indwelling catheter to treat POUR. Serum creatinine increased with combined preoperative BOO and POUR (+0.22 mg/dL) but was preserved in others (+0.02-0.04 mg/dL) (P < 0.01). Conclusions: Preoperative BOO and longer catheterization increased the risk of POUR and were associated with the use of invasive modalities to treat POUR. POUR was associated with a longer hospitalization and impaired renal function in those with preoperative BOO; therefore, renal function should be monitored closely and nephrotoxic medications used cautiously when using urinary catheters in this patient population. Level of Evidence: Retrospective Analysis, Level IV.

Published in Arthroplasty Today

ISSN: 2352-3441 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://www.journals.elsevier.com/arthroplasty-today/

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