Bladder catheterisation following joint arthroplasty is not uncommon but delaying catheterisation in the postoperative period until the patient is symptomatic can produce an atonic bladder due to the distension. This can prolong catheterisation and increase the risk of urinary tract infection. We prospectively determined if we could identify patients needing pre-operative catheterisation.

Method: 150 consecutive patients undergoing knee and hip arthroplasty were recruited. Pre-operative symptoms of frequency, nocturia, retention, incontinence and previous bladder or prostate surgery along with prior history of catheterisation were recorded. The type of anaesthesia and post-operative analgesia was noted. Details of catheterisation included duration, antibiotic administration, and reason for catheterisation and incidence of urinary tract infection.

Results: Patients mean age was 67.7 years. 47 patients required catheterisation of which 56.6% were female. The mean age of patients catheterised was 70.6 years in comparison to 66.3 years (Mann-Whitney P< 0.01). The frequency of catheterisation was unrelated to the surgical procedure.

Nocturia was significantly more common in-patients requiring catheterisation (Kruskal Wallis P=0.04) and its combination with pre-operative symptoms of frequency, retention or incontinence increased the significance further to P=0.001.

Patient age of greater then 66 years had a 76.6% predictive value for the subsequent need of catheterisation. This further increased to 91.5% when combined with a previous history of either catheterisation or nocturia. The type of anaesthesia or the post-operative analgesia did not significantly influence catheterisation frequency.

Conclusion: Patients aged greater then 66 years undergoing joint arthroplasty with previous history of catheterisation or nocturia may benefit from pre-operative bladder catheterisation. Peri-operative catheterisation of high-risk patients in theatre reduces patient discomfort caused by the observation period and avoids bladder atonia consequent of the distention, which may subsequently prolong catheterisation.