Abstract
ObjectiveThe purpose of this study is to compare the rates of urinary tract infection (UTI) and postoperative urinary retention (POUR) in patients undergoing lower limb arthroplasty after either indwelling urinary catheterization or intermittent urinary catheterization.MethodsWe conducted a meta-analysis of relevant randomized controlled trials (RCT) to compare the rates of UTI and POUR in patients undergoing total joint arthroplasty after either indwelling urinary catheterization or intermittent urinary catheterization. A comprehensive search was carried out to identify RCTs. Study-specific risk ratios (RR) with 95% confidence intervals (CI) were pooled. Additionally, a meta-regression analysis, as well as a sensitivity analysis, was performed to evaluate the heterogeneity.ResultsNine RCTs with 1771 patients were included in this meta-analysis. The results showed that there was no significant difference in the rate of UTIs between indwelling catheterization and intermittent catheterization groups (P>0.05). Moreover, indwelling catheterization reduced the risk of POUR, versus intermittent catheterization, in total joint surgery (P<0.01).ConclusionsBased on the results of the meta-analysis, indwelling urinary catheterization, removed 24-48 h postoperatively, was superior to intermittent catheterization in preventing POUR. Furthermore, indwelling urinary catheterization with removal 24 to 48 hours postoperatively did not increase the risk of UTI. In patients with multiple risk factors for POUR undergoing total joint arthroplasty of lower limb, the preferred option should be indwelling urinary catheterization removed 24-48 h postoperatively.Level of EvidenceLevel I.
Highlights
Because of the aging of population and the improvements in medical technology, there has been a major increase in the number of joint arthroplasty over the past two decades
The results showed that there was no significant difference in the rate of urinary tract infection (UTI) between indwelling catheterization and intermittent catheterization groups (P>0.05)
Indwelling catheterization reduced the risk of Postoperative urinary retention (POUR), versus intermittent catheterization, in total joint surgery (P
Summary
Because of the aging of population and the improvements in medical technology, there has been a major increase in the number of joint arthroplasty over the past two decades. According to a recent survey, the rate of joint arthroplasty increased by 59.4% from 1991 to 2010, that is, from 3.2 to 5.1 per 10,000 people [1]. Postoperative urinary retention (POUR) is a common complication following lower joint arthroplasty, and it occurs in 0–75% of patients [2]. The overall rate of POUR in the general surgical population is about 3.8%, while the rate after lower limb arthroplasty is as much as 20-folder higher [3]. For orthopaedic surgeons and nurses, the preventing POUR in total joint arthroplasty constitutes a Gordian knot of post-operative complications [7]
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