Analysis of urination and influencing factors of urodynia after urinary catheter removal in orthopedic patients_West China Medical Journal

Authors：

LIAO Haiying ,  NING Ning , CHEN Jiali , LI Peifang , XIE Jingying , LIU Ying

Department of Orthopedics, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

NING Ning, Email: gkningning@126.com

Keywords：

Postoperative; Catheter removal; Urination status; Influencing factors

DOI：

10.7507/1002-0179.202008044

Video：

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Objective To understand the urination of orthopedic patients after the catheter is removed, and to explore the influencing factors of urodynia. Methods Convenient sampling was used to select 160 patients who underwent surgical treatment in the Department of Orthopedics of West China Hospital of Sichuan University from May to July 2020. Questionnaires were used to investigate the patients’ urination, and a logistic regression model was used to analyze the factors affecting the patients’ urodynia. Results A total of 157 patients urinated by themselves after the catheter was removed, with 102 cases of dysuria. Logistic regression results showed that male [odds ratio (OR)=0.282, 95% confidence interval (CI) (0.092, 0.863), P=0.027], Huaxi Emotional-Distress Index score [OR=1.407, 95%CI (1.124, 1.760), P=0.003] and intraoperative fluid infusion [OR=1.001, 95%CI (1.000, 1.002), P=0.014] were the influencing factors of urodynia. Conclusion Most orthopedic patients can urinate on their own after the catheter is removed, but more than half of the patients experience urodynia during the first urination. Gender, mental status and intraoperative fluid infusion are the influencing factors of urodynia after urinary catheter removal after surgery. Clinical nursing staff should identify these influencing factors as soon as possible and carry out targeted interventions to improve the success rate of patients with urination after removing the catheter, reduce the incidence of urodynia, and promote the recovery of patients.

Citation： LIAO Haiying, NING Ning, CHEN Jiali, LI Peifang, XIE Jingying, LIU Ying. Analysis of urination and influencing factors of urodynia after urinary catheter removal in orthopedic patients. West China Medical Journal, 2021, 36(10): 1372-1376. doi: 10.7507/1002-0179.202008044 Copy

1.	毛海青, 周非非, 蔡思逸, 等. 经皮腰椎内镜手术加速康复外科实施流程专家共识. 中华骨与关节外科杂志, 2019, 12(9): 641-651.
2.	丁琛, 洪瑛, 王贝宇, 等. 颈椎前路手术加速康复外科实施流程专家共识. 中华骨与关节外科杂志, 2019, 12(7): 486-497.
3.	周非非, 韩彬, 刘楠, 等. 颈椎后路手术加速康复外科实施流程专家共识. 中华骨与关节外科杂志, 2019, 12(7): 498-508.
4.	中华医学会外科学分会, 中华医学会麻醉学分会. 加速康复外科中国专家共识暨路径管理指南(2018). 中华麻醉学杂志, 2018, 38(1): 8-13.
5.	Balderi T, Carli F. Urinary retention after total hip and knee arthroplasty. Minerva Anestesiol, 2010, 76(2): 120-130.
6.	Baldini G, Bagry H, Aprikian A, et al. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology, 2009, 110(5): 1139-1157.
7.	Madersbacher H, Cardozo L, Chapple C, et al. What are the causes and consequences of bladder overdistension? ICI-RS 2011. Neurourol Urodyn, 2012, 31(3): 317-321.
8.	Zhang W, Liu A, Hu D, et al. Indwelling versus intermittent urinary catheterization following total joint arthroplasty: a systematic review and meta-analysis. PLoS One, 2015, 10(7): e0130636.
9.	Pinochet R, Nogueira L, Cronin AM, et al. Role of short-term antibiotic therapy at the moment of catheter removal after laparoscopic radical prostatectomy. Urol Int, 2010, 85(4): 415-420.
10.	Meddings J, Rogers MA, Krein SL, et al. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual Saf, 2014, 23(4): 277-289.
11.	Young J, Geraci T, Milman S, et al. Risk factors for reinsertion of urinary catheter after early removal in thoracic surgical patients. J Thorac Cardiovasc Surg, 2018, 156(1): 430-435.
12.	Binhas M, Motamed C, Hawajri N, et al. Predictors of catheter-related bladder discomfort in the post-anaesthesia care unit. Ann Fr Anesth Reanim, 2011, 30(2): 122-125.
13.	Tomaszewski D, Bałkota M, Truszczyński A, et al. Intrathecal morphine increases the incidence of urinary retention in orthopaedic patients under spinal anaesthesia. Anaesthesiol Intensive Ther, 2014, 46(1): 29-33.
14.	杨翰, 曹国瑞, 裴福兴, 等. 加速康复流程下人工全膝关节置换术后留置尿管的危险因素分析. 中国修复重建外科杂志, 2020, 34(3): 357-361.
15.	唐煜东, 郑娥, 梅小丽, 等. 胸外科肿瘤患者抑郁焦虑情绪的调查分析. 中国胸心血管外科临床杂志, 2017, 24(11): 835-838.
16.	吴晓莉. 早期拔除尿管在骨科术后快速康复中的应用. 中西医结合心血管病电子杂志, 2017, 5(24): 74.
17.	Scholten R, Kremers K, van de Groes SAW, et al. Incidence and risk factors of postoperative urinary retention and bladder catheterization in patients undergoing fast-track total joint arthroplasty: a prospective observational study on 371 patients. J Arthroplasty, 2018, 33(5): 1546-1551.
18.	Choi S, Awad I. Maintaining micturition in the perioperative period: strategies to avoid urinary retention. Curr Opin Anaesthesiol, 2013, 6(3): 361-367.
19.	Peel TN, Cheng AC, Liew D, et al. Direct hospital cost determinants following hip and knee arthroplasty. Arthritis Care Res (Hoboken), 2015, 67(6): 782-790.
20.	Balderi T, Mistraletti G, D’Angelo E, et al. Incidence of postoperative urinary retention (POUR) after joint arthroplasty and management using ultrasound-guided bladder catheterization. Minerva Anestesiol, 2011, 77(11): 1050-1057.
21.	Kotwal R, Hodgson P, Carpenter C. Urinary retention following lower limb arthroplasty: analysis of predictive factors and review of literature. Acta Orthop Belg, 2008, 74(3): 332-336.
22.	Tischler EH, Restrepo C, Oh J, et al. Urinary retention is rare after total joint arthroplasty when using opioid-free regional anesthesia. J Arthroplasty, 2016, 31(2): 480-483.
23.	Kort NP, Bemelmans Y, Vos R, et al. Low incidence of postoperative urinary retention with the use of a nurse-led bladder scan protocol after hip and knee arthroplasty: a retrospective cohort study. Eur J Orthop Surg Traumatol, 2018, 28(2): 283-289.
24.	宋晶, 李琳. 留置导尿引起全身麻醉术后病人排尿感及尿痛的原因分析. 全科护理, 2013, 11(16): 1495-1496.
25.	Kim WH, Kim JT. Catheter-related bladder discomfort in gynecologic surgery. J Anesth. 2020;34(3): 478.
26.	Stish BJ, Ahmed SK, Rose PS, et al. Patient-Reported Functional and Quality of Life Outcomes in a Large Cohort of Long-Term Survivors of Ewing Sarcoma. Pediatr Blood Cancer. 2015, 62(12): 2189-2196.
27.	Dybowski C, Löwe B, Brünahl C. Predictors of pain, urinary symptoms and quality of life in patients with chronic pelvic pain syndrome (CPPS): a prospective 12-month follow-up study. J Psychosom Res, 2018, 112: 99-106.
28.	Lundberg U, Dohns IE, Melin B, et al. Psychophysiological stress responses, muscle tension, and neck and shoulder pain among supermarket cashiers. J Occup Health Psychol, 1999, 4(3): 245-255.
29.	Linton SJ, Götestam KG. Relations between pain, anxiety, mood and muscle tension in chronic pain patients. A correlation study. Psychother Psychosom, 1985, 43(2): 90-95.
30.	Bjerregaard LS, Bogø S, Raaschou S, et al. Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty. Acta Orthop, 2015, 86(2): 183-188.
31.	段闪闪, 宁宁, 周婷, 等. 加速康复外科模式下术前排尿训练联合限制性输液对人工全膝关节置换术患者术后排尿的影响. 华西医学, 2018, 33(12): 1491-1494.
32.	雷一霆, 黄强, 张少云, 等. 人工全髋关节置换术围术期限制性输液联合术前排尿训练的临床研究. 中国修复重建外科杂志, 2017, 31(11): 1295-1299.

1. 毛海青, 周非非, 蔡思逸, 等. 经皮腰椎内镜手术加速康复外科实施流程专家共识. 中华骨与关节外科杂志, 2019, 12(9): 641-651.
2. 丁琛, 洪瑛, 王贝宇, 等. 颈椎前路手术加速康复外科实施流程专家共识. 中华骨与关节外科杂志, 2019, 12(7): 486-497.
3. 周非非, 韩彬, 刘楠, 等. 颈椎后路手术加速康复外科实施流程专家共识. 中华骨与关节外科杂志, 2019, 12(7): 498-508.
4. 中华医学会外科学分会, 中华医学会麻醉学分会. 加速康复外科中国专家共识暨路径管理指南(2018). 中华麻醉学杂志, 2018, 38(1): 8-13.
5. Balderi T, Carli F. Urinary retention after total hip and knee arthroplasty. Minerva Anestesiol, 2010, 76(2): 120-130.
6. Baldini G, Bagry H, Aprikian A, et al. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology, 2009, 110(5): 1139-1157.
7. Madersbacher H, Cardozo L, Chapple C, et al. What are the causes and consequences of bladder overdistension? ICI-RS 2011. Neurourol Urodyn, 2012, 31(3): 317-321.
8. Zhang W, Liu A, Hu D, et al. Indwelling versus intermittent urinary catheterization following total joint arthroplasty: a systematic review and meta-analysis. PLoS One, 2015, 10(7): e0130636.
9. Pinochet R, Nogueira L, Cronin AM, et al. Role of short-term antibiotic therapy at the moment of catheter removal after laparoscopic radical prostatectomy. Urol Int, 2010, 85(4): 415-420.
10. Meddings J, Rogers MA, Krein SL, et al. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual Saf, 2014, 23(4): 277-289.
11. Young J, Geraci T, Milman S, et al. Risk factors for reinsertion of urinary catheter after early removal in thoracic surgical patients. J Thorac Cardiovasc Surg, 2018, 156(1): 430-435.
12. Binhas M, Motamed C, Hawajri N, et al. Predictors of catheter-related bladder discomfort in the post-anaesthesia care unit. Ann Fr Anesth Reanim, 2011, 30(2): 122-125.
13. Tomaszewski D, Bałkota M, Truszczyński A, et al. Intrathecal morphine increases the incidence of urinary retention in orthopaedic patients under spinal anaesthesia. Anaesthesiol Intensive Ther, 2014, 46(1): 29-33.
14. 杨翰, 曹国瑞, 裴福兴, 等. 加速康复流程下人工全膝关节置换术后留置尿管的危险因素分析. 中国修复重建外科杂志, 2020, 34(3): 357-361.
15. 唐煜东, 郑娥, 梅小丽, 等. 胸外科肿瘤患者抑郁焦虑情绪的调查分析. 中国胸心血管外科临床杂志, 2017, 24(11): 835-838.
16. 吴晓莉. 早期拔除尿管在骨科术后快速康复中的应用. 中西医结合心血管病电子杂志, 2017, 5(24): 74.
17. Scholten R, Kremers K, van de Groes SAW, et al. Incidence and risk factors of postoperative urinary retention and bladder catheterization in patients undergoing fast-track total joint arthroplasty: a prospective observational study on 371 patients. J Arthroplasty, 2018, 33(5): 1546-1551.
18. Choi S, Awad I. Maintaining micturition in the perioperative period: strategies to avoid urinary retention. Curr Opin Anaesthesiol, 2013, 6(3): 361-367.
19. Peel TN, Cheng AC, Liew D, et al. Direct hospital cost determinants following hip and knee arthroplasty. Arthritis Care Res (Hoboken), 2015, 67(6): 782-790.
20. Balderi T, Mistraletti G, D’Angelo E, et al. Incidence of postoperative urinary retention (POUR) after joint arthroplasty and management using ultrasound-guided bladder catheterization. Minerva Anestesiol, 2011, 77(11): 1050-1057.
21. Kotwal R, Hodgson P, Carpenter C. Urinary retention following lower limb arthroplasty: analysis of predictive factors and review of literature. Acta Orthop Belg, 2008, 74(3): 332-336.
22. Tischler EH, Restrepo C, Oh J, et al. Urinary retention is rare after total joint arthroplasty when using opioid-free regional anesthesia. J Arthroplasty, 2016, 31(2): 480-483.
23. Kort NP, Bemelmans Y, Vos R, et al. Low incidence of postoperative urinary retention with the use of a nurse-led bladder scan protocol after hip and knee arthroplasty: a retrospective cohort study. Eur J Orthop Surg Traumatol, 2018, 28(2): 283-289.
24. 宋晶, 李琳. 留置导尿引起全身麻醉术后病人排尿感及尿痛的原因分析. 全科护理, 2013, 11(16): 1495-1496.
25. Kim WH, Kim JT. Catheter-related bladder discomfort in gynecologic surgery. J Anesth. 2020;34(3): 478.
26. Stish BJ, Ahmed SK, Rose PS, et al. Patient-Reported Functional and Quality of Life Outcomes in a Large Cohort of Long-Term Survivors of Ewing Sarcoma. Pediatr Blood Cancer. 2015, 62(12): 2189-2196.
27. Dybowski C, Löwe B, Brünahl C. Predictors of pain, urinary symptoms and quality of life in patients with chronic pelvic pain syndrome (CPPS): a prospective 12-month follow-up study. J Psychosom Res, 2018, 112: 99-106.
28. Lundberg U, Dohns IE, Melin B, et al. Psychophysiological stress responses, muscle tension, and neck and shoulder pain among supermarket cashiers. J Occup Health Psychol, 1999, 4(3): 245-255.
29. Linton SJ, Götestam KG. Relations between pain, anxiety, mood and muscle tension in chronic pain patients. A correlation study. Psychother Psychosom, 1985, 43(2): 90-95.
30. Bjerregaard LS, Bogø S, Raaschou S, et al. Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty. Acta Orthop, 2015, 86(2): 183-188.
31. 段闪闪, 宁宁, 周婷, 等. 加速康复外科模式下术前排尿训练联合限制性输液对人工全膝关节置换术患者术后排尿的影响. 华西医学, 2018, 33(12): 1491-1494.
32. 雷一霆, 黄强, 张少云, 等. 人工全髋关节置换术围术期限制性输液联合术前排尿训练的临床研究. 中国修复重建外科杂志, 2017, 31(11): 1295-1299.

West China Medical Journal

Analysis of urination and influencing factors of urodynia after urinary catheter removal in orthopedic patients

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