Incidence and risk factors of postoperative urinary retention in patients undergoing hip or knee arthroplasty: a meta-analysis_West China Medical Journal

Authors：

PENG Tao , HE Yongqin , ZHAO Rongrong ,  ZHANG Yumei

Department of Orthopedics, the Second Affiliated Hospital of Army Medical University, Chongqing 400037, P. R. China;

Corresponding author：

ZHANG Yumei, Email: zhangyumei19693@sina.com

Keywords：

Hip replacement; knee replacement; postoperative urinary retention; risk factors; meta-analysis

DOI：

10.7507/1002-0179.202301030

Video：

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Objective To systematically review the incidence and risk factors of postoperative urinary retention (POUR) in patients undergoing hip or knee arthroplasty, and provide a theoretical basis for medical staff to assess and identify high-risk groups in advance. Methods PubMed, Embase, the Cochrane Library, Medline, China National Knowledge Infrastructure, Wanfang Data, VIP database, and SinoMed were electronically searched from the establishment of the databases to January 2023, for literature on the incidence and risk factors of POUR in patients undergoing hip or knee arthroplasty. Two researchers independently screened studies, extracted data, and assessed study quality. Meta-analysis was performed using Stata 14.0 software. Results A total of 21 articles were included, including 9041 patients undergoing hip or knee arthroplasty. The results of meta-analysis showed that the incidence of POUR in patients undergoing hip or knee arthroplasty was 26% [95% confidence interval (CI) (19%, 32%)]. Age [odds ratio (OR)=1.03, 95%CI (1.00, 1.05), P=0.03], male [OR=2.68, 95%CI (1.72, 4.18), P<0.001], infusion volume [OR=2.17, 95%CI (1.08, 4.35), P=0.030], spinal anesthesia [OR=1.72, 95%CI (1.29, 2.30), P<0.001], history of urinary retention/urethral stricture [OR=1.84, 95%CI (1.35, 2.49), P<0.001], use of analgesic pump [OR=4.73, 95%CI (2.29, 9.78), P<0.001], use of glycopyrronium bromide [OR=2.79, 95%CI (1.53, 5.11), P=0.001] were risk factors for POUR in patients undergoing hip or knee arthroplasty. Conclusions The incidence of POUR in patients undergoing hip or knee arthroplasty is relatively high. Age, male, infusion volume, spinal anesthesia, history of urinary retention/urethral stenosis, use of analgesia pump, and use of glycopyrronium bromide are causes of POUR. It is suggested that medical staff should identify the risk of related factors and take early intervention to reduce the occurrence of POUR.

Citation： PENG Tao, HE Yongqin, ZHAO Rongrong, ZHANG Yumei. Incidence and risk factors of postoperative urinary retention in patients undergoing hip or knee arthroplasty: a meta-analysis. West China Medical Journal, 2023, 38(9): 1338-1346. doi: 10.7507/1002-0179.202301030 Copy

1.	杨琳, 杨志英. ERAS 协会“髋/膝关节置换术围术期加速康复护理共识”解读. 护理研究, 2021, 35(11): 1881-1885.
2.	边焱焱, 程开源, 常晓, 等. 2011 至 2019 年中国人工髋膝关节置换手术量的初步统计与分析. 中华骨科杂志, 2020, 40(21): 1453-1460.
3.	Cha YH, Lee YK, Won SH, et al. Urinary retention after total joint arthroplasty of hip and knee: systematic review. J Orthop Surg (Hong Kong), 2020, 28(1): 2309499020905134.
4.	Baldini G, Bagry H, Aprikian A, et al. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology, 2009, 110(5): 1139-1157.
5.	雷一霆, 黄强, 张少云, 等. 人工全髋关节置换术围术期限制性输液联合术前排尿训练的临床研究. 中国修复重建外科杂志, 2017, 31(11): 1295-1299.
6.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
7.	何永琴, 姚爽, 张其梦, 等. 单侧髋膝关节置换患者围术期不留置尿管的可行性研究. 护理学杂志, 2019, 34(7): 50-52.
8.	潘富文, 杜秀藩, 陈小燕, 等. 椎管麻醉下全髋关节置换术后患者发生尿潴留的危险因素分析. 广西医学, 2019, 41(11): 1381-1384.
9.	杨翰, 曹国瑞, 裴福兴, 等. 加速康复流程下人工全膝关节置换术后留置尿管的危险因素分析. 中国修复重建外科杂志, 2020, 34(3): 357-361.
10.	Bjerregaard LS, Bogø S, Raaschou S, et al. Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty. Acta Orthop, 2015, 86(2): 183-188.
11.	Halawi MJ, Caminiti N, Cote MP, et al. The most significant risk factors for urinary retention in fast-track total joint arthroplasty are iatrogenic. J Arthroplasty, 2019, 34(1): 136-139.
12.	Lawrie CM, Ong AC, Hernandez VH, et al. Incidence and risk factors for postoperative urinary retention in total hip arthroplasty performed under spinal anesthesia. J Arthroplasty, 2017, 32(12): 3748-3751.
13.	Balderi T, Mistraletti G, D’Angelo E, et al. Incidence of postoperative urinary retention (POUR) after joint arthroplasty and management using ultrasound-guided bladder catheterization. Minerva Anestesiol, 2011, 77(11): 1050-1057.
14.	Ziemba-Davis M, Nielson M, Kraus K, et al. Identifiable risk factors to minimize postoperative urinary retention in modern outpatient rapid recovery total joint arthroplasty. J Arthroplasty, 2019, 34(7S): S343-S347.
15.	Griesdale DE, Neufeld J, Dhillon D, et al. Risk factors for urinary retention after hip or knee replacement: a cohort study. Can J Anaesth, 2011, 58(12): 1097-1104.
16.	Kuhn AW, Lynch JR, Ahlers CG, et al. Spinal anesthetic type and independent risk factors for postoperative urinary retention following total joint arthroplasty. J Surg Orthop Adv, 2020, 29(4): 225-229.
17.	Lingaraj K, Ruben M, Chan YH, et al. Identification of risk factors for urinary retention following total knee arthroplasty: a Singapore hospital experience. Singapore Med J, 2007, 48(3): 213-216.
18.	Scholten R, Kremers K, van de Groes SAW, et al. Incidence and risk factors of postoperative urinary retention and bladder catheterization in patients undergoing fast-track total joint arthroplasty: a prospective observational study on 371 patients. J Arthroplasty, 2018, 33(5): 1546-1551.
19.	Abdul-Muhsin HM, Jakob N, Cha S, et al. Incidence, outcomes, and prediction of postoperative urinary retention after a nonurologic procedure. J Am Acad Orthop Surg Glob Res Rev, 2020, 4(5): e1900149.
20.	Bracey DN, Hegde V, Pollet AK, et al. Incidence and predictive risk factors of postoperative urinary retention after primary total knee arthroplasty. J Arthroplasty, 2021, 36(7S): S345-S350.
21.	Hollman F, Wolterbeek N, Veen R. Risk factors for postoperative urinary retention in men undergoing total hip arthroplasty. Orthopedics, 2015, 38(6): e507-511.
22.	Kumar P, Mannan K, Chowdhury AM, et al. Urinary retention and the role of indwelling catheterization following total knee arthroplasty. Int Braz J Urol, 2006, 32(1): 31-34.
23.	Magaldi RJ, Strecker SE, Nissen CW, et al. Preoperative factors to assess risk for postoperative urinary retention in total joint arthroplasty: a retrospective analysis. Arthroplast Today, 2022, 13: 181-187.
24.	O’Riordan JA, Hopkins PM, Ravenscroft A, et al. Patient-controlled analgesia and urinary retention following lower limb joint replacement: prospective audit and logistic regression analysis. Eur J Anaesthesiol, 2000, 17(7): 431-435.
25.	Shapiro JA, Alvarez PM, Paterno AV, et al. Analysis of risks and consequences of postcatheter urinary retention after primary total hip and knee arthroplasty. Arthroplast Today, 2020, 6(4): 888-893.
26.	Cronin JJ, Shannon FJ, Bale E, et al. Prediction of post-operative urinary retention in hip and knee arthroplasty in a male population. Eur J Orthop Surg Traumatol, 2007, 17: 47-50.
27.	杜秀藩, 潘富文, 沈宁江, 等. 脊柱麻醉下股骨头置换术后尿液潴留发病率及风险因素. 中华关节外科杂志(电子版), 2019, 13(5): 541-546.
28.	谢金波, 彭波. 良性前列腺增生的流行病学特征及危险因素研究进展. 同济大学学报(医学版), 2021, 42(4): 568-573.
29.	贺必梅, 潘飞鹏. 椎管内麻醉患者术后尿潴留相关因素的研究. 实用医学杂志, 2014(18): 2970-2972.
30.	张少云, 曹国瑞, 裴福兴. 髋、膝关节置换术加速康复围术期液体治疗方案. 中国矫形外科杂志, 2018, 26(3): 234-237.
31.	李军, 于泳浩, 马虹, 等. 格隆溴铵围手术期临床应用指导意见. 国际麻醉学与复苏杂志, 2021, 42(11): 1125-1132.
32.	宋阳阳, 颜美琼, 赵俭, 等. 术后患者尿潴留风险评估研究进展. 中国护理管理, 2018, 18(2): 241-244.
33.	Luger TJ, Garoscio I, Rehder P, et al. Management of temporary urinary retention after arthroscopic knee surgery in low-dose spinal anesthesia: development of a simple algorithm. Arch Orthop Trauma Surg, 2008, 128(6): 607-612.
34.	Elkhodair S, Parmar HV, Vanwaeyenbergh J. The role of the IPSS (International Prostate Symptoms Score) in predicting acute retention of urine in patients undergoing major joint arthroplasty. Surgeon, 2005, 3(2): 63-65.

1. 杨琳, 杨志英. ERAS 协会“髋/膝关节置换术围术期加速康复护理共识”解读. 护理研究, 2021, 35(11): 1881-1885.
2. 边焱焱, 程开源, 常晓, 等. 2011 至 2019 年中国人工髋膝关节置换手术量的初步统计与分析. 中华骨科杂志, 2020, 40(21): 1453-1460.
3. Cha YH, Lee YK, Won SH, et al. Urinary retention after total joint arthroplasty of hip and knee: systematic review. J Orthop Surg (Hong Kong), 2020, 28(1): 2309499020905134.
4. Baldini G, Bagry H, Aprikian A, et al. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology, 2009, 110(5): 1139-1157.
5. 雷一霆, 黄强, 张少云, 等. 人工全髋关节置换术围术期限制性输液联合术前排尿训练的临床研究. 中国修复重建外科杂志, 2017, 31(11): 1295-1299.
6. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
7. 何永琴, 姚爽, 张其梦, 等. 单侧髋膝关节置换患者围术期不留置尿管的可行性研究. 护理学杂志, 2019, 34(7): 50-52.
8. 潘富文, 杜秀藩, 陈小燕, 等. 椎管麻醉下全髋关节置换术后患者发生尿潴留的危险因素分析. 广西医学, 2019, 41(11): 1381-1384.
9. 杨翰, 曹国瑞, 裴福兴, 等. 加速康复流程下人工全膝关节置换术后留置尿管的危险因素分析. 中国修复重建外科杂志, 2020, 34(3): 357-361.
10. Bjerregaard LS, Bogø S, Raaschou S, et al. Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty. Acta Orthop, 2015, 86(2): 183-188.
11. Halawi MJ, Caminiti N, Cote MP, et al. The most significant risk factors for urinary retention in fast-track total joint arthroplasty are iatrogenic. J Arthroplasty, 2019, 34(1): 136-139.
12. Lawrie CM, Ong AC, Hernandez VH, et al. Incidence and risk factors for postoperative urinary retention in total hip arthroplasty performed under spinal anesthesia. J Arthroplasty, 2017, 32(12): 3748-3751.
13. Balderi T, Mistraletti G, D’Angelo E, et al. Incidence of postoperative urinary retention (POUR) after joint arthroplasty and management using ultrasound-guided bladder catheterization. Minerva Anestesiol, 2011, 77(11): 1050-1057.
14. Ziemba-Davis M, Nielson M, Kraus K, et al. Identifiable risk factors to minimize postoperative urinary retention in modern outpatient rapid recovery total joint arthroplasty. J Arthroplasty, 2019, 34(7S): S343-S347.
15. Griesdale DE, Neufeld J, Dhillon D, et al. Risk factors for urinary retention after hip or knee replacement: a cohort study. Can J Anaesth, 2011, 58(12): 1097-1104.
16. Kuhn AW, Lynch JR, Ahlers CG, et al. Spinal anesthetic type and independent risk factors for postoperative urinary retention following total joint arthroplasty. J Surg Orthop Adv, 2020, 29(4): 225-229.
17. Lingaraj K, Ruben M, Chan YH, et al. Identification of risk factors for urinary retention following total knee arthroplasty: a Singapore hospital experience. Singapore Med J, 2007, 48(3): 213-216.
18. Scholten R, Kremers K, van de Groes SAW, et al. Incidence and risk factors of postoperative urinary retention and bladder catheterization in patients undergoing fast-track total joint arthroplasty: a prospective observational study on 371 patients. J Arthroplasty, 2018, 33(5): 1546-1551.
19. Abdul-Muhsin HM, Jakob N, Cha S, et al. Incidence, outcomes, and prediction of postoperative urinary retention after a nonurologic procedure. J Am Acad Orthop Surg Glob Res Rev, 2020, 4(5): e1900149.
20. Bracey DN, Hegde V, Pollet AK, et al. Incidence and predictive risk factors of postoperative urinary retention after primary total knee arthroplasty. J Arthroplasty, 2021, 36(7S): S345-S350.
21. Hollman F, Wolterbeek N, Veen R. Risk factors for postoperative urinary retention in men undergoing total hip arthroplasty. Orthopedics, 2015, 38(6): e507-511.
22. Kumar P, Mannan K, Chowdhury AM, et al. Urinary retention and the role of indwelling catheterization following total knee arthroplasty. Int Braz J Urol, 2006, 32(1): 31-34.
23. Magaldi RJ, Strecker SE, Nissen CW, et al. Preoperative factors to assess risk for postoperative urinary retention in total joint arthroplasty: a retrospective analysis. Arthroplast Today, 2022, 13: 181-187.
24. O’Riordan JA, Hopkins PM, Ravenscroft A, et al. Patient-controlled analgesia and urinary retention following lower limb joint replacement: prospective audit and logistic regression analysis. Eur J Anaesthesiol, 2000, 17(7): 431-435.
25. Shapiro JA, Alvarez PM, Paterno AV, et al. Analysis of risks and consequences of postcatheter urinary retention after primary total hip and knee arthroplasty. Arthroplast Today, 2020, 6(4): 888-893.
26. Cronin JJ, Shannon FJ, Bale E, et al. Prediction of post-operative urinary retention in hip and knee arthroplasty in a male population. Eur J Orthop Surg Traumatol, 2007, 17: 47-50.
27. 杜秀藩, 潘富文, 沈宁江, 等. 脊柱麻醉下股骨头置换术后尿液潴留发病率及风险因素. 中华关节外科杂志(电子版), 2019, 13(5): 541-546.
28. 谢金波, 彭波. 良性前列腺增生的流行病学特征及危险因素研究进展. 同济大学学报(医学版), 2021, 42(4): 568-573.
29. 贺必梅, 潘飞鹏. 椎管内麻醉患者术后尿潴留相关因素的研究. 实用医学杂志, 2014(18): 2970-2972.
30. 张少云, 曹国瑞, 裴福兴. 髋、膝关节置换术加速康复围术期液体治疗方案. 中国矫形外科杂志, 2018, 26(3): 234-237.
31. 李军, 于泳浩, 马虹, 等. 格隆溴铵围手术期临床应用指导意见. 国际麻醉学与复苏杂志, 2021, 42(11): 1125-1132.
32. 宋阳阳, 颜美琼, 赵俭, 等. 术后患者尿潴留风险评估研究进展. 中国护理管理, 2018, 18(2): 241-244.
33. Luger TJ, Garoscio I, Rehder P, et al. Management of temporary urinary retention after arthroscopic knee surgery in low-dose spinal anesthesia: development of a simple algorithm. Arch Orthop Trauma Surg, 2008, 128(6): 607-612.
34. Elkhodair S, Parmar HV, Vanwaeyenbergh J. The role of the IPSS (International Prostate Symptoms Score) in predicting acute retention of urine in patients undergoing major joint arthroplasty. Surgeon, 2005, 3(2): 63-65.

West China Medical Journal

Incidence and risk factors of postoperative urinary retention in patients undergoing hip or knee arthroplasty: a meta-analysis

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