Background: 

The purpose of this randomized controlled trial was to determine whether a short-term Foley catheter (inserted in the operating room and removed upon arrival to the orthopaedic floor) would reduce the risk of postoperative urinary retention (POUR) in patients undergoing primary total hip (THA) and total knee arthroplasty (TKA).

Methods: 

Three hundred and eighty-eight patients undergoing inpatient primary TKA (n = 228) or THA (n = 160) with spinal anesthesia were randomized to receive a short-term Foley catheter (n = 194) or no Foley (n = 194). There were 143 male and 245 female patients. The primary outcome was POUR, defined as requiring ≥2 straight catheterizations or the placement of an indwelling urinary catheter when indicated by retention of ≥450 mL on bladder scans. Secondary outcomes included urinary tract infections (UTIs) within 3 weeks and the need for ≥1 straight catheterization. A power analysis determined that 194 patients per group were required to detect a 7% minimal clinically important difference in POUR rates at 80% power and alpha of 0.05. Intention-to-treat and as-treated analyses were performed (2 patients received the non-allocated treatment). Outcomes were compared between the groups using univariate and multivariate analyses, with alpha < 0.05.

Results: 

Nine patients developed POUR: 4 in the short-term Foley group and 5 in the control group (2.1% versus 2.6%; p = 1.00). Of those who developed POUR, 8 were male and 1 was female (88.9% versus 11.1%; p = 0.002). Twenty-four patients required ≥1 straight catheterization: 10 in the Foley group and 14 in the control group (5.2% versus 7.2%; p = 0.40). Four patients developed UTIs: 3 in the Foley group and 1 in the control group (1.5% versus 0.5%; p = 0.62) on intention-to-treat analysis, and 4 in the Foley group and none in the control group (2.1% versus 0.0%; p = 0.12) on as-treated analysis.

Conclusions: 

The use of a short-term Foley catheter inserted in the operating room and removed on arrival to the orthopaedic floor does not decrease the rate of POUR.

Level of Evidence: 

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

中文翻译：

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短期留置 Foley 导尿管不会降低简单的初次 THA 和 TKA 术后尿潴留的风险：一项随机对照试验

背景： 

这项随机对照试验的目的是确定短期 Foley 导尿管（在手术室插入并在到达骨科地板后取出）是否会降低接受初次全髋关节手术的患者术后尿潴留 (POUR) 的风险（ THA）和全膝关节置换术（TKA）。

方法： 

388 名接受住院初次 TKA (n = 228) 或 THA (n = 160) 脊髓麻醉的患者被随机分配接受短期 Foley 导管 (n = 194) 或不接受 Foley (n = 194)。男性143人，女性245人。主要结果是 POUR，定义为需要 ≥ 2 次直导尿管或在膀胱扫描显示滞留 ≥ 450 mL 时留置导尿管。次要结果包括 3 周内的尿路感染 (UTI) 和需要≥1 次直接导尿。功效分析确定每组需要 194 名患者才能在 80% 的功效和 0.05 的 alpha 下检测 POUR 率的 7% 最小临床重要差异。进行了意向治疗和实际治疗分析（2 名患者接受了非分配治疗）。

结果： 

9 名患者出现 POUR：短期 Foley 组 4 名，对照组 5 名（2.1% 对 2.6%；p = 1.00）。在出现 POUR 的患者中，8 名男性和 1 名女性（88.9% 对 11.1%；p = 0.002）。24 名患者需要≥1 次直接导尿：Foley 组 10 名，对照组 14 名（5.2% 对 7.2%；p = 0.40）。4 名患者发生尿路感染：根据意向治疗分析，Foley 组有 3 名，对照组有 1 名（1.5% 对 0.5%；p = 0.62），Foley 组有 4 名，对照组没有（2.1%）对比 0.0%；p = 0.12) 处理后分析。

结论： 

使用在手术室插入并在到达骨科地板时移除的短期 Foley 导管不会降低 POUR 的发生率。

证据等级： 

治疗一级。有关证据等级的完整描述，请参阅作者须知。