Dear Panayot

The urethral catheter is rarely used in my artrhroplasties

May I ask you what kind of anesthesia do you use in THR and TKA?

Dear Panayot

Epidural or spinal anesthesia in most cases

Thank you, Nelson. I do not like using urethral catheters perioperatively. But in regional anesthesia it seems to be the less evil.

not necessary in normal cases, only in known urin-incontinence or prostratic retention, or in exchange-cases, which take serveral hours, so that the anaethesist has the chance to make the calculations of body-water compensation.

Thank you very much for the very interesting and relevant question.

Considering the morbidity that can be caused by urinary catheterization in THR and TKR patients, where early ambulation and bed-pan use is possible, it appears to be reasonable and feasible for not using it. At maximum, drainage of bladder can be done once immediately after operation by clean technique. However in practice, it is often done. This is because

1. Some patients are co-morbid and needs hourly urine output monitoring

2. These cases are done often under spinal or combined spinal epidural, which can cause postop urinary retention (comparatively more than general anesthesia- https://doi.org/10.1016/j.egja.2014.12.002

3. Many a hospital and surgeon do not do same day ambulation

4. Surgical time is another factor. Although these procedure should not take longer duration in expert hand, but, not all of us are so fast. This point leads to addition of adjuvant in the spinal anesthesia, which further increases the urinary retention.

The other point is that urinary catheterization in such patients are mostly done only for a day and UTI from catheter usually is rare in one day (https://dx.doi.org/10.2147%2FRRU.S75419).

I shall be happy to know your data and experience in this interesting aspect.

It is also a patient satisfaction issue. The women do not particularly care for bedpan use, and nobody particularly cares to be catheterized while awake. As stated by another response, the UTI rate for

No. Urinary catheter is not essential but desired, because elderly population usually have a retention in post operative phase and we don’t want any messy dressing in post operative phase.