I usually prefer an indwelling catheter during surgery in a hip arthroplasty and get it out the next morning or as soon as the patient is comfortable and stable. Recently I was faced with a situation during a planned complex primary hip wherein we detected inability to catheterise due to major urethral surgery. On table prior to positioning the urosurgeon opined need for three weeks of suprapubic catheterisation, further urinary evaluation and probably reconstruction. As we had not begun yet we deferred the hip for later. My contention was the increased risk for SSI with an indwelling Suprapubic catheter and repeated urethral procedures would be too high and therefore it would be ideal to complete that aspect first and do the hip.
I have never had a problem with my urinary catheter protocol either in spine surgery or in hip or knee surgery. But with a Suprapubic catheter I am not too sure of the risks.
Actually they are maxing non-invasive catheters, that have the top part shaped like a condom and should be put in place like that, while all the tubing and the bag is the same as an ordinary catheter. So you can avoid any extra incision, will all the problems that could came from that.
Suprapubic catheter is a sort of salvage procedure. I believe in this case the urological problem should be solved first and then one should go over to the elective hip surgery .
We routinely do not use urinary catheter except in complex or long lasting primary total hip replacement. However the case you are refering with difficult catheterization due to mayor urethral surgery I believe that suprapubic catheter increase risk of infection so urological problem should be solved before elective hip surgery
My concern with catheterisation is in men; passing a urinary catheter through a hypertrophied prostate could result in a bacteraemia which is not ideal when an arthroplasty is imminent. Thus, I prefer not to catheterise unless retention develops post-operatively, and if so, then I routinely give gentamicin prophylaxis at catheterisation.
Thank you, Matt, for your proper answer. The problem in men is sometimes a trouble. Unfortunately, the regional (spinal) anaesthesia that we routinely use lasts fo several hours and the full bladder is problematic. So we usually insert an urethral catheter and remove it as soon as the sensation is recovered. I find the application of gentamycin for prophylactic goal problematic. We use a perioperative antibiotic prophylaxis (generation I or II cephalosporins). I believe this combination is good but "too good" for prophylactic needs.
Dear Antonio,
Thats exactly what we did. The urological problem is being sorted out.
Dear Matt, I agree but like Dr Tanchev said, the problem does arise when spinal lasts too long.
Thanks for the opinions
Murali
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