URINARY RETENTION FOLLOWING ARTHROPLASTY

Abstract

Acute urinary retention (AUR) is a common complication following arthroplasty of the major joints and may lead to a delayed discharge with financial considerations not to mention the risks of sepsis – in the urinary tract and also rarely but very significantly in the joint itself. Our aim was to study the various factors associated with risk of AUR following arthroplasty.

We conducted a retrospective review of all available casenotes of patients undergoing total hip (THR) and knee arthroplasty (TKR) in a consecutive three year period. Variables noted included rate of AUR, catheterisation, urinary tract infection (UTI), urinanalysis, joint sepsis, anaesthetic type, use of patient controlled analgesia, postoperative morphine requirement, alpha blockade, past medical and urological history.

100 patients underwent THR. AUR occurred in 22%. Deep joint sepsis occurred in 1% – this patient had not been catheterised. 3% had positive urine analysis but were asymptomatic. No patients had a symptomatic postoperative UTI. 117 patients underwent TKR. AUR occurred in 19%. The rate of deep joint sepsis was 0.85%. There was one case of superficial infection. Neither of these cases was catheterised. There were no cases of postoperative UTI. There was correlation between previous AUR and incidence of AUR (p=0.95).

There was no significant correlation between past medical history and AUR contrary to reports by previous authors. The correlation between previous AUR with risk of AUR in the TKR group warrants further investigation. Catheterisation has been previously thought to be associated with infection. In our study with cefuroxime at induction and two doses postoperatively and gentamicin for catheter insertion and removal there were no cases of postoperative UTI and although deep sepsis was seen it was not associated with catheterisation either pre-operatively, perioperatively or postoperatively in AUR.