Posteropartive Urinary Retention: A Case Study

The overuse of Foley catheters can lead to urinary tract infections (UTIs) which in turn can lead to a hip prosthesis infection in patients that have undergone THA. An additional risk of the overuse of Foley catheters is posteropartive urinary retention (POUR) in total joint arthroplasty patients. As POUR develops, patients are subjected to intermittent catheterizations on the nursing units, which increases the risk of developing a UTI. The anesthetic used also plays an important role in the development of POUR.
Spinal anesthesia decreases the risk of POUR and therefore decreases the need for Foley catheterization. The group most at-risk for developing POUR after THA surgery are males aged 70 or older with a history of benign prostatic hypertophy
This has created a wide variety of protocols in the orthopedic society as no concensus currently exists. The determination of POUR is generally identified as an inability to void despite a full bladder, bladder volume exceeding 400 to 600 mL immediately or within 6 to 8 hours after surgery, and the need for catheterization (Miller et al., 2013; Hollman et al., 2015; Fernandez et al., 2014 and Balderi, Mistraletti, D'Aangelo, & Carli, 2011). Miller et al. (2013) found that using the International Prostate Symptom Score (IPSS) can be used to effectively predict the patients that are at an increased risk of developing POUR postoperatively. Using the IPSS along with other diagnostic criteria, such as medical history, surgical history and a physical examination can minimize the overuse of indwelling catheters and decrease the risk of UTI in the THA population. The purpose of this draft manuscript is to identify the beginning work of my scholarly practice project on adult men undergoing total hip arthroplasty surgery with spinal anesthesia and the appropriateness of using preoperative screening tool to identify the at-risk patients that will require a Foley catheter.
Project Question
In adult men undergoing total hip arthroplasty having spinal anesthesia (P), how does inserting a Foley catheter before surgery (I) compare to not having a Foley catheter before surgery (C) affect postoperative urinary retention (O) within six months (T)? The purpose of this project is to decrease the overuse of Foley catheterizations for men undergoing THA surgery under spinal anesthesia over a six-month period.
Literature Synthesis (External