Indwelling versus Intermittent Urinary Catheterization following Total Joint Arthroplasty: A Systematic Review and Meta-Analysis

<div><p>Objective</p><p>The purpose of this study is to compare the rates of urinary tract infection (UTI) and postoperative urinary retention (POUR) in patients undergoing lower limb arthroplasty after either indwelling urinary catheterization or intermittent urinary catheterization.</p><p>Methods</p><p>We conducted a meta-analysis of relevant randomized controlled trials (RCT) to compare the rates of UTI and POUR in patients undergoing total joint arthroplasty after either indwelling urinary catheterization or intermittent urinary catheterization. A comprehensive search was carried out to identify RCTs. Study-specific risk ratios (RR) with 95% confidence intervals (CI) were pooled. Additionally, a meta-regression analysis, as well as a sensitivity analysis, was performed to evaluate the heterogeneity.</p><p>Results</p><p>Nine RCTs with 1771 patients were included in this meta-analysis. The results showed that there was no significant difference in the rate of UTIs between indwelling catheterization and intermittent catheterization groups (<i>P</i>>0.05). Moreover, indwelling catheterization reduced the risk of POUR, versus intermittent catheterization, in total joint surgery (<i>P</i><0.01).</p><p>Conclusions</p><p>Based on the results of the meta-analysis, indwelling urinary catheterization, removed 24-48 h postoperatively, was superior to intermittent catheterization in preventing POUR. Furthermore, indwelling urinary catheterization with removal 24 to 48 hours postoperatively did not increase the risk of UTI. In patients with multiple risk factors for POUR undergoing total joint arthroplasty of lower limb, the preferred option should be indwelling urinary catheterization removed 24-48 h postoperatively.</p><p>Level of Evidence</p><p>Level I.</p></div

Egger’s publication bias plot.

<p>Egger’s publication bias plot.</p

Flow chart summarizing the selection process of studies.

<p>Flow chart summarizing the selection process of studies.</p

Studies used for the meta-analysis.

<p>¹ the duration of indwelling catheterization</p><p>Studies used for the meta-analysis.</p

Forest plot for postoperative urinary retention.

<p>Forest plot for postoperative urinary retention.</p

Study quality.

<p>¹ Only if the method of sequence made was explicitly introduced could get a ‘Yes’.</p><p>² Drop-out rate <20% could get a ‘Yes’, otherwise ‘No’.</p><p>³ ITT = intention-to-treat, only if all randomized participants were analyzed in the group they were allocated to could receive a ‘Yes’.</p><p>⁴ “Yes” items more than 7 means ‘High’; more than 4 but no more than 7 means ‘Moderate’; no more than 4 means ‘Low’.</p><p>Study quality.</p

Sensitivity analyses of urinary tract infection.

<p>Sensitivity analyses of urinary tract infection.</p

Forest plot for urinary tract infection.

<p>Forest plot for urinary tract infection.</p