Gryet Inger Markussen, Graugaard-Jensen Charlotte, Pedersen Asger Roer, Skov Simon Toftgaard
University Clinic for Interdisciplinary Orthopaedic Pathways, Elective Surgery Centre, Silkeborg Regional Hospital, Central Region Denmark, Denmark.
Pelvic Floor Unit, Department of urology, Aarhus University Hospital, Denmark.
JB JS Open Access. 2025 May 1;10(2). doi: 10.2106/JBJS.OA.24.00180. eCollection 2025 Apr-Jun.
Postvoid residual urine (PVR) can be an unknown chronic disorder, or it can occur after surgery. A pilot study led to development of a flowchart suggesting performing preoperative and postoperative bladder scans and recommending men with PVR further diagnostic work-up. This study aimed to determine the prevalence of preoperative and postoperative PVR in men older than 65 years undergoing major elective orthopaedic surgery and also to determine risk factors and possibility of prediction.
This was a single-center cohort study. The patients were consecutively included for 1 year from April 2022. Data were extracted from the electronic patient files: age, lower urinary tract symptoms (LUTS), comorbidity, type of surgery and anesthesia, opioid use, and preoperative and postoperative PVR which was defined as ≥150 ml.
A total of 796 men were eligible for inclusion: 316 knee, 276 hip, and 26 shoulder arthroplasties and 178 lower back spinal surgeries. Preoperative bladder scans were acquired in 95% of the eligible patients, and PVR was found in 15% (confidence interval [CI] 12-18). There was a higher risk of preoperative PVR in men reporting LUTS, OR 1.97 (1.28-3.03); neurological disease, OR 3.09 (1.41-6.74); and the risk increased with higher age, OR 1.08 per year (1.04-1.12). PVR was found in 9% of the men without risk factors. A postoperative bladder scan was performed in 72% of the men. Among men without preoperative PVR, 15% (CI 12-19) had postoperative PVR de novo. The highest risk for PVR postoperative was PVR preoperatively.
Preoperatively, 15% had PVR. Neurological disease, LUTS, and higher age were identified as risk factors, but PVR was found in 9% of the men without risk factors. In men without preoperative PVR, 15% had postoperative PVR de novo. It is not possible to conclude whether PVR is transient or chronic, and it is unclear whether a PVR of 150 ml is associated with complications or if the threshold should be higher. This study highlights the importance of awareness regarding voiding issues before and after surgery.
Level III. See Instructions for Authors for a complete description of levels of evidence.
残余尿量（PVR）可能是一种不明的慢性疾病，也可能在手术后出现。一项初步研究促成了一个流程图的制定，该流程图建议进行术前和术后膀胱扫描，并建议有PVR的男性进一步进行诊断性检查。本研究旨在确定接受大型择期骨科手术的65岁以上男性术前和术后PVR的患病率，并确定风险因素及预测的可能性。
这是一项单中心队列研究。从2022年4月起连续1年纳入患者。数据从电子病历中提取：年龄、下尿路症状（LUTS）、合并症、手术和麻醉类型、阿片类药物使用情况，以及术前和术后PVR（定义为≥150 ml）。
共有796名男性符合纳入标准：316例行膝关节置换术、276例行髋关节置换术、26例行肩关节置换术以及178例行下背部脊柱手术。95%的符合条件的患者进行了术前膀胱扫描，发现15%的患者存在PVR（置信区间[CI]12 - 18）。报告有LUTS的男性术前发生PVR的风险更高，比值比（OR）为1.97（1.28 - 3.03）；患有神经系统疾病的男性，OR为3.09（1.41 - 6.74）；且风险随年龄增长而增加，每年OR为1.08（1.04 - 1.12）。9%无风险因素的男性存在PVR。72%的男性进行了术后膀胱扫描。在术前无PVR的男性中，15%（CI 12 - 19）术后新发PVR。术后发生PVR的最高风险因素是术前存在PVR。
术前，15%的患者存在PVR。神经系统疾病、LUTS和高龄被确定为风险因素，但9%无风险因素的男性也存在PVR。在术前无PVR的男性中，15%术后新发PVR。无法确定PVR是短暂性的还是慢性的，也不清楚150 ml的PVR是否与并发症相关，或者阈值是否应该更高。本研究强调了对手术前后排尿问题的认识的重要性。
III级。有关证据水平的完整描述，请参阅《作者须知》。
