The Role of the IPSS in Predicting AUR in Patients Undergoing Major Joint Arthroplasty


S. Elkhodair, et al. Surgeon, April 1, 2005, P 63-65.

Elkhodair and colleagues study the role of the International Prostate Symptom Score (IPSS) in predicting acute urinary retention (AUR) in patients undergoing major joint arthroplasty. Ninety-five male patients scheduled for either total hip or knee replacement, completed an IPSS and a midstream urine specimen culture as part of the standard pre-operative assessment. Their ages ranged from 22 to 87 years (mean 69.5 years). Post-operatively patients were monitored for occurrence of AUR and other urinary complications. Thirty-two men (average age 73.2 years) experienced AUR and were treated with Foley catheters under antibiotic cover with Tamsulosin 400mcg where appropriate. This group represented 17.7% of men with mild (0-7), 55.5% of men with moderate (8-18), and 100% of men with severe (>18) IPSS scores. Statistical analysis confirmed the relationship between IPSS and incidence of AUR (t test; p<0.0001). The authors recommend male arthroplasty patients complete an IPSS prior to their surgery to help identify those at greater risk of AUR. The surgeon can use the results to recommend to moderate and high-risk patients either perioperative catheterization or surgical delay until the lower urinary tract symptoms has been remedied by the urologist. The authors note that intra-operative placement of catheters in a controlled and sterile environment reduces the risk of contamination and subsequent infection. Patients also responded they would prefer catheterization while under anesthesia.

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