Yoeri Bemelmans

Postoperative urinary retention after hip and knee arthroplasty 61 5 Introduction Since the introduction of fast-track surgery pathways in orthopedic departments, peri- and postoperative indwelling bladder catheterization is no longer routinely performed [19,22,27]. Postoperative urinary retention (POUR), defined as the inability to empty the bladder voluntary after anesthesia and surgery, is a commonly reported adverse event after elective total hip- (THA) and knee arthroplasty (TKA) [1,2,4,5]. The reported incidence of POUR after TKA and THA following a fast-track or conventional pathway ranges widely between 0-75% [1,4-6,16,17,27]. Many factors contribute to the risk of POUR, such as type of anesthesia, male gender, comorbidities and perioperative fluid management [2,3,4-6,13,21]. An ultrasound bladder scan is introduced as a diagnostic tool to monitor bladder volume in the prevention of POUR [8,9,18]. General consensus on definition of POUR, cut-off values, time of measurement with a bladder scan and treatment strategies (intermittent vs. indwelling catheterization) is lacking [4,14,29]. Most studies reported POUR as the inability to void spontaneously after surgery with a high bladder volume, ranging between 400-800ml [2,5,6]. As other studies defined POUR as the need for postoperative urologic consultation [26] or the postoperative inability to void spontaneously without monitoring bladder volume [21,27]. Based on physiological knowledge, exceeding 600ml of bladder volume is considered to be pathophysiological [29]. The potential risk of POUR is overdistension of the bladder, which can cause urologic adverse events [3]. Indications for postoperative catheterization after THA and TKA in fast-track surgery are based on the bladder volume and is widely diverse in literature [1-3,5,6] ranging from 400-800ml. Early detection and treatment of POUR is paramount in prevention of bladder overdistension and thereby urologic adverse events [23]. Treatment of POUR consists of intermittent or indwelling catheterization, which both is often associated with an increased risk of urinary tract infection, morbidity and prolonged hospital stay [7,25,29]. With the use of an ultrasound-guided bladder scan protocol, elective bladder catheterization is unnecessary in patients undergoing THA and TKA [2]. However, there is limited evidence regarding a standardized pre-, peri- and postoperative bladder scan protocol with general applicable cut-off values and strategies regarding the treatment of high bladder volumes to prevent for POUR [2,5,14,18]. This study reports the incidence and the potential risk factors for POUR, after elective fast-track hip- and knee arthroplasty, when using a nurse-led bladder scan protocol.