Postoperative urinary retention (POUR) in fast-track total hip and knee arthroplasty

Abstract

Postoperative urine retention (POUR) is a well-known complication in hip (THA) and knee arthroplasty (TKA), but with a variable incidence ranging from 0% to 75% (Balderi and Carli 2010). Although different pharmacological approaches have been attempted to avoid POUR, the results have been inconclusive or controversial (Baldini et al. 2009), leaving indwelling or intermittent bladder catheterization as the only option for prevention and treatment of POUR. However, both POUR and catheterization may increase the risk of urinary tract infection, with subsequent risk of wound and prosthesis infection and/or renal impairment (Madersbacher et al. 2012). Also, POUR and its sequelae may prevent early mobilization, which is essential in fast-track THA and TKA, and may prolong hospitalization and increase re-admission rates (Kehlet 2013). Although fast-track THA and TKA and early mobilization may potentially facilitate restoration of bladder function due to improved pain management with opioid-sparing analgesia, no large-scale data exist on the incidence of POUR and its consequences in fast-track settings. Consequently, POUR should be prioritized by orthopedic surgeons and nurses to develop evidence-based guidelines on prevention and treatment of POUR in fast-track THA and TKA, including efforts to identify patients who are at increased risk of developing POUR.