Is Routine Urinary Catheterization Necessary in Elective Hip Surgery?

Allan S. Brett, MD

In a randomized trial, the answer clearly was no . . . with some caveats.

Indwelling bladder catheters frequently are placed in patients undergoing total hip arthroplasty with spinal anesthesia, presumably to lower risk for postoperative urinary retention. To determine whether this practice makes sense, researchers at a Philadelphia hospital randomized 200 such patients (mean age, 59; 50% women) to receive either an indwelling urinary catheter (placed during surgery and removed within 48 hours) or no catheter. Standard protocols for both groups outlined criteria for postoperative urinary retention and need for in-and-out catheterization.

Of 107 no-catheter patients, 9 developed urinary retention postoperatively, 8 of whom were managed successfully with a single in-and-out-catheterization. Of 93 indwelling-catheter patients, 3 developed urinary retention after the catheter was removed; 2 of these patients were managed with a single catheterization, and the third required three catheterizations and a nephrology consultation. Three indwelling-catheter patients (vs. 0 no-catheter patients) developed urinary tract infections.

Citation(s):

Miller AG et al. Spinal anesthesia: Should everyone receive a urinary catheter? — A randomized, prospective study of patients undergoing total hip arthroplasty. J Bone Joint Surg Am 2013 Aug 21; 95:1498.