A less invasive catheterization protocol for managing urinary retention in patients undergoing hip and knee arthroplasty: A prospective cohort study

Background

Postoperative urinary retention is a frequently seen serious complication after surgery. After orthopaedic hip or knee arthroplasty the incidence is relatively high, between 30 and 50% in previous studies. Currently, there is no consensus on the indication for urinary catheterization and a uniform guideline is lacking. This prospective cohort study examined the safety of a modified catheterization protocol with a catheterization threshold of 800 ml instead of 400 ml (usual care) after elective joint arthroplasty using ultrasound bladder scans. The hypothesis was that the incidence of catheterization will be reduced without increasing urinary complications.

Method

We prospectively included 305 patients who were treated according to the local fast track arthroplasty protocol in which a modified catheterization protocol was used. Catheterization was only performed at a scan volume of 800 ml or more. Bladder contents were monitored preoperatively, immediately postoperatively and at outpatient follow-up. Urological scores and complications were monitored. The usual care control group was treated according to the usual care protocol with a threshold for catheterization of 400 ml, these results were published in a previous study.

Results

The incidence of catheterization for urinary retention was significantly lower in patients who were treated with the less invasive protocol than the usual care control group (11.1% versus 48.8%, p < 0.001). The rate of urologic complications was low using the new protocol (4% urinary tract infection and 0.3% pharmacological interventions).

Conclusion

The results of our study provide strong empirical support for modifying catheterization protocols after orthopaedic surgery. A less invasive protocol is safe, provides reduction in workload for nurses, is patient-friendly and reduces costs.