Santini Alasdair Ja, Jakaraddi Chetan A, Polydoros Fotis, Metikala Sree
1 The Lower Limb Arthroplasty Unit, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
2 St Helens and Knowsley Hospital NHS Trust, Merseyside, UK.
J Orthop Surg (Hong Kong). 2019 Sep-Dec;27(3):2309499019868670. doi: 10.1177/2309499019868670.
Postoperative urinary retention necessitating catheterization after major lower limb arthroplasty surgery adds to the patients' postoperative discomfort and increases the risk of urinary tract infection with potential risk of transient bacteraemia and seeding of infection to prosthetic joints. Preoperative evaluation of patients with lower urinary tract symptoms may help to identify at-risk patients and the International Prostate Symptoms Score (IPSS) has been used as a screening tool to quantify the severity of symptoms in males. A prospective cohort of 303 patients undergoing total hip or knee arthroplasty was evaluated using the IPSS. Patients were categorized into three symptom groups (mild, moderate and severe based on scores of 0-7, 8-18 and greater than 18, respectively) and four age groups (<50 years, 51-60 years, 61-70 years and greater than 70 years). Twenty-six patients (8.6%) developed urinary retention and were catheterized postoperatively; of these, 16 were male and 10 were female. Statistical analysis using logistic regression models showed significant association between severe IPSS scores (>18) and urinary retention requiring catheterization in both males and females with both high specificity and sensitivity in the test in predicting postoperative catheterization. Hence, this test is a valid preoperative screen in predicting postoperative catheterization.
下肢大关节置换术后需要导尿的术后尿潴留会增加患者术后的不适，并增加尿路感染的风险，还可能存在短暂菌血症以及感染播散至人工关节的潜在风险。对有下尿路症状的患者进行术前评估可能有助于识别高危患者，国际前列腺症状评分（IPSS）已被用作一种筛查工具来量化男性症状的严重程度。使用IPSS对303例接受全髋关节或膝关节置换术的患者进行了前瞻性队列研究。患者被分为三个症状组（轻度、中度和重度，分别基于0 - 7分、8 - 18分和大于18分）和四个年龄组（<50岁、51 - 60岁、61 - 70岁和大于70岁）。26例患者（8.6%）发生尿潴留并在术后进行了导尿；其中，16例为男性，10例为女性。使用逻辑回归模型进行的统计分析显示，严重的IPSS评分（>18）与男性和女性术后需要导尿的尿潴留之间存在显著关联，该测试在预测术后导尿方面具有高特异性和敏感性。因此，这项测试是预测术后导尿的有效术前筛查方法。
