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Investigating Postoperative Urinary Retention: Risk Factors and Postsurgical Outcomes in Total Joint Arthroplasty.

Madeleine J F Powers¹, Zachary T Grace², Barrett B Torre²

¹University of New England College of Osteopathic Medicine, Biddeford, ME, USA.

Arthroplasty Today

|January 15, 2025

Summary

Postoperative urinary retention (POUR) after total joint arthroplasty (TJA) has varying rates and risk factors. Patients needing 4+ catheters face a 10-fold risk of complications, highlighting the need for reduced catheterization.

Keywords:

Catheterization Postoperative complications Postoperative urinary retention Total joint arthroplasty Urinary tract infection

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Area of Science:

Orthopedic Surgery
Urology
Anesthesiology

Background:

Postoperative urinary retention (POUR) is a complication following total joint arthroplasty (TJA).
Diagnostic criteria, prevalence, and risk factors for POUR remain inconsistent.
This study addresses these inconsistencies in the TJA population.

Purpose of the Study:

Quantify the incidence rates of POUR after TJA.
Identify significant risk factors associated with POUR development.
Assess complications related to catheterization in TJA patients with POUR.

Main Methods:

Retrospective cohort review of 17,220 TJA patients (January 2015 - December 2022).
POUR incidence calculated using three distinct diagnostic criteria.
Analysis of patient demographics, comorbidities, surgical factors, and anesthesia type.

Main Results:

POUR incidence ranged from 20% to 29% depending on diagnostic criteria.
Risk factors included advanced age, male gender, lower BMI, moderate CCI, TKA, spinal anesthesia, and alpha-blocker use.
Patients receiving 4+ catheters showed a 10-fold increased risk of renal/infectious complications.

Conclusions:

Diagnostic variability for POUR after TJA persists.
Frequent catheterization (4+ instances) significantly elevates renal/infectious complication risk.
Risk stratification and reduced catheterization frequency are crucial for mitigating POUR-related complications.