title: Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty.
abstract: OBJECTIVE
  Postoperative urinary retention (POUR) is a clinical challenge, but there is no scientific evidence for treatment principles. We describe the incidence of and predictive factors for POUR in fast-track total hip (THA) and knee arthroplasty (TKA).
  
  
  METHODS
  This was a prospective observational study involving 1,062 elective fast-track THAs or TKAs, which were performed in 4 orthopedics departments between April and November 2013. Primary outcome was the incidence of POUR, defined by postoperative catheterization. Age, sex, anesthetic technique, type of arthroplasty, and preoperative international prostate symptom score (IPSS) were compared between catheterized and non-catheterized patients.
  
  
  RESULTS
  The incidence of POUR was 40% (range between departments: 30-55%). Median bladder volume evacuated by catheterization was 0.6 (0.1-1.9) L. Spinal anesthesia increased the risk of POUR (OR = 1.5, 95% CI: 1.02-2.3; p = 0.04) whereas age, sex, and type of arthroplasty did not. Median IPSS was 6 in non-catheterized males and 8 in catheterized males (p = 0.02), but it was 6 in the females in both groups (p = 0.4).
  
  
  CONCLUSIONS
  The incidence of POUR in fast-track THA and TKA was 40%, with spinal anesthesia and increased IPSS in males as predictive factors. The large variation in perioperative bladder management and in bladder volumes evacuated by catheterization calls for randomized studies to define evidence-based principles for treatment of POUR in the future.
authors.affiliation: Section for Surgical Pathophysiology 4074, Rigshospitalet, Copenhagen University, Denmark.
authors.forename: Lars S
authors.initials: LS
authors.lastname: Bjerregaard
authors.forename: Stina
authors.initials: S
authors.lastname: Bogø
authors.forename: Sofie
authors.initials: S
authors.lastname: Raaschou
authors.forename: Charlotte
authors.initials: C
authors.lastname: Troldborg
authors.forename: Ulla
authors.initials: U
authors.lastname: Hornum
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Poulsen
authors.forename: Per
authors.initials: P
authors.lastname: Bagi
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal / Q000706:statistics & numerical data*; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D014546:Urinary Catheterization / Q000706:statistics & numerical data*; D016055:Urinary Retention / Q000453:epidemiology*; D055815:Young Adult