Perioperative bladder management after primary total hip arthroplasty

Area of Science:

• Orthopedic Surgery
• Urology
• Patient Care Management

Background:

• Postoperative urinary retention is a common complication following total hip arthroplasty (THA).
• Effective bladder management protocols are crucial for patient recovery and comfort.
• Two common protocols include pro re nata (PRN) straight catheterization and indwelling catheterization.

Purpose of the Study:

• To compare the clinical outcomes of two distinct postoperative bladder management protocols in primary THA patients.
• To evaluate the incidence of urinary retention and bladder distention between the two groups.
• To assess the association between preoperative factors and postoperative urinary complications.

Main Methods:

• A retrospective review of 95 consecutive primary THA patients was conducted.
• Group 1 (n=49) received a PRN straight catheterization protocol.
• Group 2 (n=46) received an indwelling catheterization protocol.

Main Results:

• Group 2 demonstrated significantly lower incidences of urinary retention (P < .0005) and bladder distention (P < .0005) compared to Group 1.
• No correlation was found between preoperative systemic diseases/urologic symptoms and postoperative urinary complications.
• Group 1 had no infections, while Group 2 had one case of bacteriuria and one urinary tract infection (2% each), potentially linked to a 72-hour catheterization duration.

Conclusions:

• Indwelling catheterization is more effective in preventing urinary retention and bladder distention post-THA than PRN straight catheterization.
• While indwelling catheters reduce acute urinary issues, a potential trend towards increased bacteriuria/UTI exists with longer catheter duration.
• Bladder management strategies should balance the prevention of retention with the risk of infection.