Pre-Operative Urodynamic Assessment Has Poor Predictive Value for Developing Post-Operative Urinary Retention.

Area of Science:

• Urology
• Orthopedics
• Surgical Outcomes

Background:

• Post-operative urinary retention (POUR) affects up to 35% of patients undergoing total joint arthroplasty (TJA).
• Urologic disease history is a known risk factor for POUR.
• Pre-operative post-void residual (PVR) volumes have not been evaluated for POUR risk assessment.

Purpose of the Study:

• To investigate the efficacy of pre-operative urodynamic measurements, including PVR and subjective scores, in predicting POUR risk in male TJA patients.
• To determine if PVR and urologic disease history can reliably identify patients at high risk for POUR.

Main Methods:

• A pre-operative screening protocol including PVR, urinary retention scores, and urologic disease assessment was applied to male TJA patients.
• Prospectively collected data were retrospectively analyzed using chi-squared tests and logistic regression.
• Receiver-operator characteristic (ROC) curves were used to evaluate the predictive performance of urodynamic variables.

Main Results:

• The overall POUR rate was 5.1% in 252 male TJA patients (mean age 64.9 years, BMI 30.8 kg/m²).
• Elevated pre-operative PVR (>10 cc), with or without a history of urologic disease, was significantly associated with POUR, but with low positive predictive values (10.5% and 18.2%).
• PVR demonstrated moderate sensitivity (91.6%) but low specificity (72.1%) for predicting POUR.

Conclusions:

• Pre-operative urodynamic measurements and subjective urinary retention scores have limited value in identifying male TJA patients at increased risk for POUR.
• The clinical utility of routine pre-operative PVR measurements for POUR risk stratification in this population is questionable.