Urinary retention following total hip and knee arthroplasty is a common problem frequently requiring catheterisation in the immediate post-operative period. The direct relationship between urinary tract instrumentation and deep sepsis in total hip replacements is well documented.

Method: This prospective study analysed 164 male patients who underwent primary arthroplasty between September 2004 and March 2005 inclusive. Patients who had previous urological intervention for obstructive symptoms were excluded from the study. Upon admission and prior to surgery, all patients answered an 8-point urinary symptom questionnaire and were tested on their ability to micturate while supine.

Result: 34 patients required urinary catheterisation – 130 did not. The average age of the catheterised group was 69.5+/−10.7 years (range 45–90) and the non catheterised group was 65.2+/−10.5 years (range 33–85). There was no difference between these groups (p=0.134, ANOVA). Similarly, there was not difference (p=0.919, ANOVA) between the blood loss in the 2 groups, 880.6+/−455.5 mls and 895+/−533.7 mls respectively. With regards to the symptom questionnaire, the average score in the catheter group was 3.1+/−2.4 and the non-catheter group was 2.0+/−1.8 (p=0.034, ANOVA). The ability to micturate in a supine position was of no predictive value with 22 patients in the catheter group able to do so.

Conclusion: These results show the value of a urinary symptom questionnaire used pre-operatively in predicting those who may require post-operative urinary catheterisation. By appropriate use of this tool, patients with potential for post-operative retention may be identified before surgery. Consequently, this group should be catheterised pre-operatively thus reducing their risk of infection.