Urethral catheters are associated with urinary infections which could set an arthroplastry at risk for early or late infection. Nevertheless, some surgeons and anesthesilogists use urethral catheter for control of diuresis in the perioperative period. Is it really necessary?
Dear Dr Tanchev
I believe it is a necessary evil. It is necessary to keep the catheter in the preoperative period to ensure patient comfort, ease of nursing, need for monitoring and especially in the presence of multiple comorbidities. However, having said that, I do like the catheter out the morning after surgery once the patient is reasonably comfortable. My patients find this much more comfortable than no catheter and the extreme discomfort of not being able to void easily in the post op period. Not to forget, I sleep easier too.
Regards
Murali
Thank You Drs Tanchev and Poduval for this interesting, relevant discussion on a significant dilemna in lower limb arthroplasty surgery.
In my clinical practice, i have moved away from using a catheter routinely, unless the patient's past medical history and co-morbidities dictate the use of one.
There is a lot of evidence out there regarding the increased incidence of urinary retention in lower limb arthroplasty, increased prevalence of UTIs with the use of urinary catheters with the duration of catheterisation being the most significant risk factor, and post-op UTIs leading to haematogenous bacteremia, seeding of the implant and subsequent Prosthetic Joint Infections.
Neuraxial anaesthesia has long been considered to be an indication for the use of a urinary catheter because of the potential lack of ability to sense bladder distention and subsequent neurogenic bladder problems. It has been shown previously that post-op urinary retention following spinal anaesthesia is significantly lower than that after epidural anaesthesia.
Anaesthetic practices have changed in recent years. Epidural anaesthesia is less commonly utilised for lower limb arthroplasty. In spinal anaesthesia, no intrathecal opiates are used and the current emphasis is on enhanced recovery and rapid rehab with multimodal analgesia which has conclusively shown a significant reduction in the need and use of opiates.
Based on these facts and also because i would like to emphasise and reassure my arthroplasty patients that they are not ill and only have had a procedure done, i have given up the use of a urinary catheter routinely as it is one less tube that these patients are attached to.
I would recommend this publication from the Parvizi group at the Rothman Institute which discusses all these relevant points.
Article Spinal Anesthesia: Should Everyone Receive a Urinary Cathete...
Thank you, Dr. Prasad for your relevant posting. I share entirely your opinion and practice.
Regards
I agree. Urinary catheterisation doesn't need to be performed routinely for all lower limb arthroplasties but should be considered in certain cases. Spinal anaesthesia may be a relative indication for catheterisation but certainly not an absolute, and I would also consider the likely surgical duration and any other urinary tract issues (e.g. prostatism).
I would add that one needs to be particularly mindful of perioperative fluid management in patients receiving spinal anaesthesia without urinary catheterisation. Both acute urinary retention and the discomfort of a urinary catheter (especially if unexpected) can cause significant distress and agitation in the early postoperative period.
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