Comparison Of Indwelling And Intermittent Urinary Catheterization In Total Hip Or Knee Arthroplasty:a Meta-analysis

Background. Urinary retention is a common complication following total joint arthroplasty. Urinary catheterization prevents postoperative urinary retention, but increases the risk of urinary tract infection. There is limited evidence as to whether indwelling or intermittent urinary catheterization should be the preferred choice for perioperative bladder management in patients undergoing total joint arthroplasty. A meta-analysis was performed to evaluate the difference between indwelling and intermittent urinary catheterization in patients undergoing total hip or knee arthroplasty.Methods. Online databases, including PubMed, MEDLINE,Cochrane Library, and EMBASE, were searched for randomized controlled trials comparing indwelling with intermittent urinary catheterization in total hip or knee arthroplasty. All eligible studies were assessed the methodological strength according to a modified version of the generic evaluation tool recommended by the Cochrane Bone, Joint and Muscle Trauma Group. The Review Manager software was used to perform the meta-analysis to compare the incidence of postoperative urinary retention and urinary tract infection between the two methods of bladder management.Results. Our meta-analysis of six randomized controlled trials with a total of1216patients showed the relative risk of postoperative urinary retention between indwelling and intermittent catheterization was0.12(95%CI,0.04-0.36:p=0.0002), the relative risk of urinary tract infection was1.25(95%CI,0.75-2.09;p=0.38),the relative risk of deep wound infection was2.61(95%CI,0.11-63.33;p=0.56), and the relative risk of number of patients requiring more than one catheterization was0.28(95%CI,0.00-38.10;p=0.61).The mean number of catheterizations per patient in indwelling groups was1.27. compared with2.65in intermittent groups. Of the628patients in intermittent groups,246(39.2%) did not undergo urinary catheterization. In terms of costs associated with the two catheterization methods, two studies preferred indwelling catheterization, but another preferred intermittent catheterization.Conclusions. Indwelling urinary catheterization in total hip or knee arthroplasty significantly decreased the incidence of urinary retention, but did not significantly increase the incidence of urinary tract infection. About40%patients in intermittent groups did not require urinary catheterization. The patients in intermittent groups required about twice catheterizations as many as those in indwelling groups. There was no significant difference in the percentage of patients that required more than one catheterization in both groups. We were unable to determine which urinary catheterization method was more cost-effective. Further high-quality randomized controlled trials are required to assess the cost-effectiveness of perioperative bladder management.