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Spinal Anesthesia: Should Everyone Receive a Urinary Catheter?: A Randomized, Prospective Study of Patients Undergoing Total Hip Arthroplasty

Miller, Adam G. MD; McKenzie, James BS; Greenky, Max BA; Shaw, Erica RNP; Gandhi, Kishor MD; Hozack, William J. MD; Parvizi, Javad MD, FRCS

Journal of Bone & Joint Surgery - American Volume: 21 August 2013 - Volume 95 - Issue 16 - p 1498–1503
doi: 10.2106/JBJS.K.01671
Scientific Articles

Background: The objective of this randomized prospective study was to determine whether a urinary catheter is necessary for all patients undergoing total hip arthroplasty under spinal anesthesia.

Methods: Consecutive patients undergoing total hip arthroplasty under spinal anesthesia were randomized to treatment with or without insertion of an indwelling urinary catheter. All patients received spinal anesthesia with 15 to 30 mg of 0.5% bupivacaine. The catheter group was subjected to a standard postoperative protocol, with removal of the indwelling catheter within forty-eight hours postoperatively. The experimental group was monitored for urinary retention and, if necessary, had straight catheterization up to two times prior to the placement of an indwelling catheter.

Results: Two hundred patients were included in the study. There was no significant difference between the two groups in terms of the prevalence of urinary retention, the prevalence of urinary tract infection, or the length of stay. Nine patients in the no-catheter group and three patients in the catheter group (following removal of the catheter) required straight catheterization because of urinary retention. Three patients in the catheter group and no patient in the no-catheter group had development of urinary tract infection.

Conclusions: Patients undergoing total hip arthroplasty under spinal anesthesia appear to be at low risk for urinary retention. Thus, a routine indwelling catheter is not required for such patients.

Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

1Rothman Institute (A.G.M., J.M., M.G.,W.J.H., J.P.), Department of Orthopaedic Surgery (E.S.), and Department of Anesthesia (K.G.),Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107. E-mail address for J. Parvizi:

Copyright 2013 by The Journal of Bone and Joint Surgery, Incorporated
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