Postoperative Urinary Retention in Total Joint Arthroplasty

USA: 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. R.J. Magaldi et al. conducted a study 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 postvoid bladder scans before surgery. Bladder scan volumes were correlated with catheterization via Chi square 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.

The authors concluded that this is the first study performed on a TJA population showing that a preoperative post-void residual threshold of 50 ml is associated with POUR.

This study confirms previous research demonstrating intraoperative IV fluid volume as a significant risk factor and also introduces a lower threshold for preoperative PVRV as an additional risk factor for POUR in TJA.

The authors recommend routine preoperative bladder ultrasonography to detect residual volumes, close monitoring of IV fluid volumes intraoperatively, and regular bladder scanning after surgery, as well as repeatedly encouraging patients to void, as part of a urinary protocol.

Key Words

Post-operative urinary retention, Total joint arthroplasty, Catheterization, Risk factors, Post void residual Bladder ultrasonography

Further Reading

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

Robert James Magaldi, Sara Elaine Strecker, Carl W. Nissen, Robert James Carangelo, John Grady-Benson.

Arthroplasty Today 13 (2022) 181-187

https://doi.org/10.1016/j.artd.2021.10.009