scholarly journals Predicting postoperative urinary retention after lower limb arthroplasty

2012 ◽  
Vol 94 (5) ◽  
pp. 356-358 ◽  
Author(s):  
WKM Kieffer ◽  
TPC Kane
Keyword(s):  
Urinary Retention ◽  
Lower Limb ◽  
Scoring System ◽  
Total Joint Replacement ◽  
Joint Arthroplasty ◽  
Easy Method ◽  
Postoperative Urinary Retention ◽  
Risk Patients ◽  
Male Patients ◽  
Selection Of

A simple scoring system that enables surgeons to make an estimation of the likelihood of postoperative urinary retention (POUR) in patients undergoing lower limb total joint replacement would be a useful one. This would enable selection of high risk patients who merit pre-operative catheterisation in a clean theatre environment rather than risking urinary retention and its associated complications late at night on the ward by junior, inexperienced staff. The International Prostate Symptom Score (IPSS) is such a scoring system and we assessed its reliability in predicting those male patients likely to go into POUR. We selected all male patients undergoing lower limb total joint arthroplasty under spinal anaesthesia and calculated their IPSS. We found a statistically significant increase in the likelihood of POUR as IPSS rises (p=0.0002). We concluded that the IPSS is a quick and easy method of predicting those at risk of POUR, allowing them to be catheterised prophylactically, preventing possible complications.

scholarly journals Postoperative Urinary Retention Following General Anesthesia for Endoscopic Nasal Surgery in Men Aged Older Than 60 Years: A Retrospective Study

2021 ◽  
pp. 014556132110331
Author(s):  
Yong Won Lee ◽  
Bum Sik Kim ◽  
Jihyun Chung
Keyword(s):  
General Anesthesia ◽  
Incidence Rate ◽  
Urinary Retention ◽  
Nasal Surgery ◽  
Prostate Hyperplasia ◽  
Postoperative Urinary Retention ◽  
Asa Classification ◽  
History Of ◽  
Male Patients ◽  
Endoscopic Nasal Surgery

Objectives: Postoperative urinary retention (POUR) is influenced by many factors, and its reported incidence rate varies widely. This study aimed to investigate the occurrence and risk factors for urinary retention following general anesthesia for endoscopic nasal surgery in male patients aged >60 years. Methods: A retrospective review of medical records between January 2015 and December 2019 identified 253 patients for inclusion in our study. Age, body mass index (BMI), a history of diabetes/hypertension, American Society of Anesthesiologists (ASA) classification, and urologic history were included as patient-related factors. Urologic history was subdivided into 3 groups according to history of benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and current medication. The following was analyzed as perioperative variables for POUR development: duration of anesthesia and surgery; amount of fluid administered; rate of fluid administration; intraoperative requirement for fentanyl, ephedrine, and dexamethasone; postoperative pain; and analgesic use. Preoperatively measured prostate size and uroflowmetry parameters of patients on medication for symptoms were compared according to the incidence of urinary retention. Results: Thirty-seven (15.7%) patients developed POUR. Age (71.4 vs 69.6 years), BMI (23.9 vs 24.9 kg/m2), a history of diabetes/hypertension, ASA classification, and perioperative variables were not significantly different between patients with and without POUR. Only urologic history was identified as a factor affecting the occurrence of POUR ( P = .03). The incidence rate among patients without urologic issues was 5.9%, whereas that among patients with BPH/LUTS history was 19.8%. Among patients taking medication for symptoms, the maximal and average velocity of urine flow were significantly lower in patients with POUR. Conclusions: General anesthesia for endoscopic nasal surgery may be a potent trigger for urinary retention in male patients aged >60 years. The patient’s urological history and urinary conditions appear to affect the occurrence of POUR.

scholarly journals Can a Urinary Tract Symptom Score Predict the Development of Postoperative Urinary Retention in Patients Undergoing Lower Limb Arthroplasty Under Spinal Anaesthesia? A Prospective Study

2006 ◽  
Vol 88 (4) ◽  
pp. 394-398 ◽  
Author(s):  
SM Sarasin ◽  
MJ Walton ◽  
HP Singh ◽  
DI Clark
Keyword(s):  
Urinary Tract ◽  
Urinary Retention ◽  
Lower Limb ◽  
Close Monitoring ◽  
Prospective Audit ◽  
Postoperative Urinary Retention ◽  
Predicted Probability ◽  
Spinal Anaesthetic ◽  
Symptom Severity Score ◽  
A Prospective Study

INTRODUCTION There is no general consensus amongst orthopaedic surgeons on how best to manage the urinary tract and its complications after lower limb arthroplasty. This prospective audit investigates whether postoperative urinary retention can be predicted pre-operatively using the validated International Prostate Symptom Severity score (IPSS). PATIENTS AND METHODS A total of 182 patients undergoing lower limb arthroplasty under spinal anaesthetic were given the IPSS questionnaire to complete pre-operatively and an audit into numbers catheterised postoperatively was performed. RESULTS Overall, 69% of males and 39% of females required catheterisation. Following logistic regression analysis there was 0.85 predicted probability that males over 70 years would require catheterisation. The IPSS score was not useful in predicting retention in either sex at any age. CONCLUSIONS We propose that all males over 70 years undergoing this type of surgery should be catheterised pre-operatively and all other patients should be catheterised postoperatively with close monitoring of bladder volumes to prevent established urinary retention.

scholarly journals The incidence of postoperative urinary retention in patients undergoing elective hip and knee arthroplasty

2014 ◽  
Vol 96 (6) ◽  
pp. 462-465 ◽  
Author(s):  
MA Fernandez ◽  
S Karthikeyan ◽  
M Wyse ◽  
P Foguet
Keyword(s):  
Urinary Retention ◽  
Spinal Anaesthesia ◽  
Lower Limb ◽  
Femoral Nerve Block ◽  
Intrathecal Morphine ◽  
Femoral Nerve ◽  
Postoperative Urinary Retention ◽  
Female Patients ◽  
Urethral Catheterisation ◽  
Hip And Knee Arthroplasty

Introduction Postoperative urinary retention requiring urethral catheterisation increases the risk of joint sepsis following arthroplasty. Spinal anaesthesia with opiate administration is used widely in lower limb arthroplasty. We sought to establish whether the choice of opiate agent had any effect on the incidence of postoperative retention and therefore the risk of joint sepsis. Methods A total of 445 consecutive patients who underwent primary elective lower limb arthroplasty were reviewed retrospectively. Patients had general anaesthesia and femoral nerve block (GA+FNB), spinal anaesthesia and intrathecal fentanyl (SA+ITF) or spinal anaesthesia and intrathecal morphine (SA+ITM). Results Urinary retention was observed in 14% of male and 2% of female patients with GA+FNB, 9% of male and 3% of female patients with SA+ITF, and 60% of male (p=0.0005) and 5% of female patients with SA+ITM. Men who experienced retention were older (68 vs 64 years, p=0.013) and had longer inpatient stays (6.7 vs 4.6 days, p=0.043). Fewer patients in the SA+ITM group required breakthrough analgesia (28% vs 58%, p=0.004). Concusions The use of ITM in men significantly increases the incidence of urinary retention requiring urethral catheterisation and subsequently increases the risk of deep joint sepsis. Its use should be rationalised against the intended benefits and alternatives sought where possible.

scholarly journals Implementation and Validation of the 2013 Caprini Score for Risk Stratification of Arthroplasty Patients in the Prevention of Venous Thrombosis

2019 ◽  
Vol 25 ◽  
pp. 107602961983806 ◽  
Author(s):  
Eugene S. Krauss ◽  
Ayal Segal ◽  
MaryAnne Cronin ◽  
Nancy Dengler ◽  
Martin L. Lesser ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Risk Stratification ◽  
Total Joint Replacement ◽  
Joint Arthroplasty ◽  
Assessment Model ◽  
Study Group ◽  
Risk Assessment Model ◽  
Inclusion Criteria ◽  
Secondary Purpose ◽  
Selection Of

Appropriate chemoprophylaxis choice following arthroplasty requires accurate patient risk assessment. We compared the results of our prospective department protocol to the Caprini risk assessment model (RAM) retrospectively in this study group. Our goal was to determine whether the department protocol or the Caprini score would identify venous thromboembolism (VTE) events after total joint replacement. A secondary purpose was to validate the 2013 Caprini RAM in joint arthroplasty and determine whether patients with VTE would be accurately identified using the Caprini score. A total of 1078 patients met inclusion criteria. A Caprini score of 10 or greater is considered high risk and a score of 9 or less is considered low risk. The 2013 version of the Caprini RAM retrospectively stratified 7 of the 8 VTE events correctly, while only 1 VTE was identified with the prospective department protocol. This tool provided a consistent, accurate, and efficacious method for risk stratification and selection of chemoprophylaxis.

Scoring system for the selection of high-risk patients in the intensive care unit

2006 ◽  
Vol 34 (4) ◽  
pp. 1039-1043 ◽  
Author(s):  
Gaetano Iapichino ◽  
Giovanni Mistraletti ◽  
Davide Corbella ◽  
Gabriele Bassi ◽  
Erika Borotto ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Scoring System ◽  
High Risk Patients ◽  
Risk Patients ◽  
Selection Of
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