Post-operative Urinary Dysfunction Following Shoulder Surgery: Rates and Risk Factors

Document Type : RESEARCH PAPER

Authors

1 The Carrell Clinic, Dallas, TX, USA

2 Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA, USA

3 University of Miami, Miller School of Medicine, Miami, FL, USA

4 IHA Orthopaedic Surgery Associates at St. Joe’s Ann Arbor, Ypsilanti, MI, USA

Abstract

Background: Post-operative urinary retention (POUR) and dysfunction are recognized complications following
orthopaedic surgery. Recent literature has focused on urinary retention and its associated complications following hip
and knee reconstruction and lower extremity surgery. There is a paucity of literature focusing on POUR and shoulder
surgery. The purpose of this study is to describe the rates of urinary dysfunction in patients undergoing shoulder surgery
as well as the associated risk factors.
Methods: This was a single institution, prospective cohort study. Eligibility criteria included patients older than 50
years of age undergoing open or arthroscopic shoulder surgery. The primary outcome was the American Urological
Association (AUA) symptom score (7 questions total scored 0-5, total 35 points max) administered before and after
surgery. Higher scores reflect worse urinary dysfunction. Intra-operative data such as type of surgery, type of anesthesia,
use of anticholinergics, peripheral nerve block, length of case, and amount of intravenous fluids were collected.
Results: Of 194 patients, the mean age was 61.4 years (Standard Deviation (S.D.) = 13.0)) and the average BMI was
29.2 (S.D. = 5.6). The sample was 35.6% female. Overall, 46.4% reported worse AUA scores post-operatively within the
first 3 to 5 days, including 4.1% of which were clinically defined as “moderately worse” (>5 point worse) or “much worse”
(>11 points worse). Worse preoperative AUA scores correlated with worse postop AUA score on linear regression
analysis (r=0.883, P<0.0001). Males with a history of BPH showed a statistically significant positive association with
worsening urinary dysfunction postoperatively (P=0.039). Four patients (2.1%) required postoperative catheterization.
A significantly higher percentage of patients with preoperative AUA scores of ≥11 experienced worsening of urinary
function post-operatively (P=0.04).
Conclusion: Worsening of urinary function following shoulder surgery is common. The AUA score may be used to
identify at-risk patients and to track changes in urinary function post-operatively. Men with a diagnosis of BPH are at
particularly high risk. Further investigation is needed to elucidate the impact of urinary dysfunction on patient outcomes,
satisfaction, and cost as well as the role of prophylactic medications.
Level of evidence: II

Keywords

Main Subjects

References

1. Dillon MT, Chan PH, Inacio MCS, Singh A, Yian EH,
Navarro RA. Yearly Trends in Elective Shoulder
Arthroplasty, 2005–2013. Arthritis Care Res
2017;69:1574–81. doi: 10.1002/acr.23167.
2. Jensen AR, Cha PS, Devana SK, et al. Evaluation of the
trends, concomitant procedures, and complications
with open and arthroscopic rotator cuff repairs in
the medicare population. Orthop J Sport Med 2017; 5,
1–7. doi: 10.1177/2325967117731310.
3. Balderi T, Carli F. Urinary retention after total
hip and knee arthroplasty. Minerva Anestesiol.
2010;76,2:120–30.
4. Balderi T, Mistraletti G, D’Angelo E, Carli F. Incidence
of postoperative urinary retention (POUR) after joint
arthroplasty and management using ultrasoundguided
bladder catheterization. Minerva Anestesiol
.2011;77,11:1050–7.
5. Berend KR, Lombardi AV Jr, Berend ME, Adams JB,
Morris MJ. The outpatient total hip arthroplasty: A
paradigm change. Bone Joint J. 2018;100B(1 Supple
A):31–5. doi:10.1302/0301-620X.100B1.BJJ-2017-
0514.R1
6. Kumar P, Mannan K, Chowdhury AM, Kong KC,
Pati J. Urinary retention and the role of indwelling
catheterization following total knee arthroplasty. Int
Braz J Urol.2006;32:31–4.
7. Lawrie CM, Ong AC, Hernandez VH, Rosas S,
Post ZD, Orozco FR. Incidence and Risk Factors
for Postoperative Urinary Retention in Total Hip
Arthroplasty Performed Under Spinal Anesthesia.
J Arthroplasty .2017;32:3748-1. doi: 10.1016/j.
arth.2017.07.009.
8. Scholten R, Kremers K, van de Groes SAW, Somford DM.
Koëter S. 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;33:1546–51. doi:
10.1016/j.arth.2017.12.001.
9. Baldini G, Bagry H, Aprikian A, Carli F. Postoperative
Urinary Retention. Anesthesiology. 2009;110:1139–
57. doi: 10.1097/ALN.0b013e31819f7aea.
10. Darrah DM, Griebling TL, Silverstein JH. Postoperative
Urinary Retention. Anesthesiol Clin. 2009;27:465–84.
doi: 10.1016/j.anclin.2009.07.010.
11. David M, Arthur E, Dhuck R, Hemmings E, Dunlop
D. High rates of postoperative urinary retention
following primary total hip replacement performed
under combined general and spinal anaesthesia with
intrathecal opiate. J Orthop 2015;12:S157–0. doi:
10.1016/j.jor.2015.10.020.
12. Gandhi SD, Patel SA, Maltenfort M, Anderson DG,
Vaccaro AR, Albert TJ, et al. Patient and surgical factors
associated with postoperative urinary retention after
lumbar spine surgery. Spine. 2014;39:1905–9. doi:
10.1097/BRS.0000000000000572.
13. David TS, Vrahas MS. Perioperative lower urinary tract
infections and deep sepsis in patients undergoing
total joint arthroplasty. J Am Acad Orthop Surg
2000;8:66–74.
14. Navarro RA, Lin CC, Foroohar A, Crain SR, Hall MP.
Unplanned emergency department or urgent care
visits after outpatient rotator cuff repair: potential
for avoidance. J Shoulder Elbow Surg. 2018;27:993–7.
doi: 10.1016/j.jse.2017.12.011.
15. Hollman F, Wolterbeek N, Veen R. Risk factors for
postoperative urinary retention in men undergoing
total hip arthroplasty. Orthopedics. 2015;38:e507–
11. doi: 10.3928/01477447-20150603-59.
16. Ziemba-Davis M, Nielson M, Kraus K, Duncan N,
Nayyar N, Meneghini RM. Identifiable Risk Factors to
Minimize Postoperative Urinary Retention in Modern
Outpatient Rapid Recovery Total Joint Arthroplasty.
J Arthroplasty. 2019;34:S343–7. doi: 10.1016/j.
arth.2019.03.015.
17. Barry MJ, Fowler FJ Jr, O’Leary MP, et al. The
American Urological Association Symptom Index
for Benign Prostatic Hyperplasia. The Measurement
Committee of the American Urological Association.
J Urol. 1992;148(5):1549–57. doi: 10.1016/s0022-
5347(17)36966-5.
18. Plante M, Corcos J, Gregoire I, Belanger MF, Brock G,
Rossingol M. The international prostate symptom
score: Physician versus self-administration in
the quantification of symptomatology. Urology
1996;47:326–8. doi: 10.1016/s0090-4295(99) 80447-6.
19. Fuller TW, Ristau BT, Tepe SM, Benoit RM. Characterizing
Clinically Meaningful Changes in Lower Urinary Tract
Symptoms Using the American Urological Association
Symptom Index. Urology 2018;115:139–43. doi:
10.1016/j.urology.2018.01.024.
20. Bose, B. Analysis or evaluation of risk factors and
predictability of postoperative urinary retention
following spinal surgery. Spine J. 2017;17:478–9. doi:
10.1016/j.spinee.2017.01.008.
21. Fraser JF, Danoff JR, Manrique J, Reynolds MJ,
Hozack WJ. Identifying Reasons for Failed Same-Day
Discharge Following Primary Total Hip Arthroplasty.
J Arthroplasty. 2018;33:3624-8. doi: 10.1016/j.
arth.2018.08.003.
22. Golubovsky JL, Ilyas H, Chen J, Tanenbaum JE, Steinmetz
MP. Risk factors and associated complications for
postoperative urinary retention after lumbar surgery
for lumbar spinal stenosis. Spine 2018;18:1533–9.
doi: 10.1016/j.spinee.2018.01.022.
23. Halawi MJ, Caminiti N, Cote MP, Lindsay AD, Williams
VJ. The Most Significant Risk Factors for Urinary
Retention in Fast-track Total Joint Arthroplasty
are Iatrogenic. J Arthroplasty. 2019;34:136–9. doi:
10.1016/j.arth.2018.08.042.
24. Johansson, RM, Christensson L. Urinary retention in
older patients in connection with hip fracture surgery.
J Clin Nurs. 2010;19:2110–6. doi: 10.1111/j.1365-
2702.2010.03261.x. 25. Kieffer WK, Kane TP. Predicting postoperative urinary
retention after lower limb arthroplasty. Ann R Coll
Surg Engl.2012;94:356–8. doi: 10.1308/003588412X
13171221591691.
26. Mayo BC, Louie PK, Bohl DD, et al. Effects of
intraoperative anesthetic medications on
postoperative urinary retention after single-level
lumbar fusion. Spine. 2016;41:1441–6. doi: 10.1097/
BRS.0000000000001554
27. Akgün D, Müller M, Perka C, Winkler T. An oftenunrecognized
entity as cause of recurrent infection
after successfully treated two-stage exchange
arthroplasty: hematogenous infection. Arch. Orthop.
Trauma Surg. 2018;138:1199–1206. doi: 10.1007/
s00402-018-2972-3.
28. Peersman G, Laskin R, Davis J, Peterson M. Infection
in Total Knee Replacement. Clin Orthop Relat Res.
2001;392:15–23.
29. Elkhodair S, Parmar HV, Vanwaeyenbergh J. The role
of the IPSS (International Prostate Symptoms Score)
in predicting acute retention of urine in patients
undergoing major joint arthroplasty. Surgeon
2005;3(2):63–5. 10.1016/s1479-666x (05)80063-0.
30. Madani AH, Aval HB, Mokhtari G, et al. Effectiveness
of tamsulosin in prevention of post-operative
urinary retention: A randomized double-blind
placebocontrolled study. Int Braz J Urol. 2014;40:30–
6. doi: 10.1590/S1677-5538.IBJU.2014.01.05.
31. Mohammadi-Fallah M, Hamedanchi S, Tayyebi-Azar
A. Preventive effect of tamsulosin on postoperative
urinary retention. Korean J Urol 2012;53:419–23. doi:
10.4111/kju.2012.53.6.419
32. Schubert MF, Thomas JR, Gagnier JJ, et al. The AAHKS
Clinical Research Award: Prophylactic Tamsulosin
Does Not Reduce the Risk of Urinary Retention
Following Lower Extremity Arthroplasty: A Double-
Blinded Randomized Controlled Trial. J Arthroplasty.
2019;34:S17–23. doi: 10.1016/j.arth.2019.03.039.
The Archives of Bone and Joint Surgery
Volume 10, Issue 12
December 2022
Pages 1020-1025

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History

  • Receive Date: 06 February 2022
  • Revise Date: 07 March 2022
  • Accept Date: 28 April 2022
  • First Publish Date: 14 November 2022

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