Post-operative urinary retention after lower extremity arthroplasty and the peri-operative role of selective alpha-1 adrenergic blocking agents in adult male patients: a propensity-matched retrospective cohort study

  • Manuel F. Schubert
  • Jared R. Thomas
  • Jacob Yashar
  • John J. Lee
  • Andrew G. Urquhart
  • Joel J. Gagnier
  • Aidin Eslam PourEmail author
Original Paper



The purpose of this study was to determine whether male patients taking pre-operative selective alpha-1 adrenergic blocking agents have a lower likelihood of developing post-operative urinary retention (POUR) and a shorter length of hospitalization following lower extremity arthroplasty.


A retrospective cohort study was conducted of patients who underwent primary or revision total hip or knee arthroplasty, or unicompartmental knee arthroplasty at an academic institution from January 2002 to May 2014. A cohort of male patients aged 35 and older who were taking a selective alpha-1 blocker prior to surgery (N = 229) were compared with a control group (N = 330) not taking one of these medications. Propensity score–matched logistic regression was performed to isolate the effect of taking a selective alpha-1 blocker on POUR.


When evaluating for the outcome of POUR while controlling for age, hypertension, benign prostatic hyperplasia, urinary tract infections, type of anaesthesia, and procedure, those patients taking an alpha-1 blocker had a 12.1% decreased relative risk (95% CI 3.4 to 20.8%; p = 0.007) of developing POUR compared with patients not taking these medications. Mean length of stay was 3.8 days (95% CI 3.6 to 4.1) in the cohort taking selective alpha-1 blockers compared with 4.7 days (95% CI 4.4 to 4.9) for the control cohort.


After controlling for known risk factors for the development of POUR, the use of selective alpha-1 blockers pre-operatively reduces the risk of developing urinary retention after lower extremity arthroplasty and is associated with a 1-day decreased length of stay.


Urinary retention Hip Knee Arthroplasty Post-operative Alpha blocker 


Funding information

Funding for the study was provided by the University of Michigan Orthopaedic Research Advisory Committee Resident Research Grant.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


  1. 1.
    Balderi T, Carli F (2010) Urinary retention after total hip and knee arthroplasty. Minerva Anestesiol 76:120–130PubMedGoogle Scholar
  2. 2.
    Bjerregaard LS, Bogo S, Raaschou S et al (2015) Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty. Acta Orthop 86:183–188CrossRefGoogle Scholar
  3. 3.
    Balderi T, Mistraletti G, D’Angelo E, Carli F (2011) Incidence of postoperative urinary retention (POUR) after joint arthroplasty and management using ultrasound-guided bladder catheterization. Minerva Anestesiol 77:1050–1057PubMedGoogle Scholar
  4. 4.
    Fernandez MA, Karthikeyan S, Wyse M, Foguet P (2014) The incidence of postoperative urinary retention in patients undergoing elective hip and knee arthroplasty. Ann R Coll Surg Engl 96:462–465CrossRefGoogle Scholar
  5. 5.
    Griesdale DE, Neufeld J, Dhillon D et al (2011) Risk factors for urinary retention after hip or knee replacement: a cohort study. Can J Anaesth 58:1097–1104CrossRefGoogle Scholar
  6. 6.
    Kotwal R, Hodgson P, Carpenter C (2008) Urinary retention following lower limb arthroplasty: analysis of predictive factors and review of literature. Acta OrthopBelg 74:332–336Google Scholar
  7. 7.
    Kumar P, Mannan K, Chowdhury AM et al (2006) Urinary retention and the role of indwelling catheterization following total knee arthroplasty. Int Braz J Urol 32:31–34CrossRefGoogle Scholar
  8. 8.
    Izard JP, Sowery RD, Jaeger MT, Siemens DR (2006) Parameters affecting urologic complications after major joint replacement surgery. Can J Urol 13:3158–3163PubMedGoogle Scholar
  9. 9.
    Petersen MS, Collins DN, Selakovich WG, Finkbeiner AE (1991) Postoperative urinary retention associated with total hip and total knee arthroplasties. Clin Orthop Relat Res 269:102–108Google Scholar
  10. 10.
    Schubert MF, Thomas JR, Gagnier JJ et al (2019) The AAHKS Clinical Research Award: prophylactic tamsulosin does not reduce the risk of urinary retention following lower extremity arthroplasty: a double-blinded randomized controlled trial. J Arthroplasty 34:S17–S23CrossRefGoogle Scholar
  11. 11.
    Baldini G, Bagry H, Aprikian A, Carli F (2009) Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology 110:1139–1157CrossRefGoogle Scholar
  12. 12.
    David TS, Vrahas MS (2000) Perioperative lower urinary tract infections and deep sepsis in patients undergoing total joint arthroplasty. J Am Acad Orthop Surg 8:66–74CrossRefGoogle Scholar
  13. 13.
    Koulouvaris P, Sculco P, Finerty E et al (2009) Relationship between perioperative urinary tract infection and deep infection after joint arthroplasty. Clin Orthop Relat Res 467:1859–1867CrossRefGoogle Scholar
  14. 14.
    Madani AH, Aval HB, Mokhtari G et al (2014) Effectiveness of tamsulosin in prevention of post-operative urinary retention: a randomized double-blind placebo-controlled study. Int Braz J Urol 40:30–36CrossRefGoogle Scholar
  15. 15.
    Mohammadi-Fallah M, Hamedanchi S, Tayyebi-Azar A (2012) Preventive effect of tamsulosin on postoperative urinary retention. Korean J Urol 53:419–423CrossRefGoogle Scholar
  16. 16.
    Kennedy EH, Greene MT, Saint S (2013) Estimating hospital costs of catheter-associated urinary tract infection. J Hosp Med 8:519–522CrossRefGoogle Scholar
  17. 17.
    Saint S, Meddings JA, Calfee D et al (2009) Catheter-associated urinary tract infection and the Medicare rule changes. Ann Intern Med 150:877–884CrossRefGoogle Scholar
  18. 18.
    Belmont PJ Jr, Goodman GP, Waterman BR et al (2014) Thirty-day postoperative complications and mortality following total knee arthroplasty: incidence and risk factors among a national sample of 15,321 patients. J Bone Joint Surg Am 96:20–26CrossRefGoogle Scholar
  19. 19.
    Iorio R, Healy WL, Patch DA, Appleby D (2000) The role of bladder catheterization in total knee arthroplasty. Clin Orthop Relat Res 380:80–84CrossRefGoogle Scholar
  20. 20.
    Tammela T, Kontturi M, Puranen J (1987) Prevention of postoperative urinary retention after total hip arthroplasty in male patients. Ann Chir Gynaecol 76:170–172PubMedGoogle Scholar
  21. 21.
    Jeong IG, You D, Yoon JH et al (2014) Impact of tamsulosin on urinary retention following early catheter removal after robot-assisted laparoscopic radical prostatectomy: a prospective randomized controlled trial. Int J Urol 21:164–168CrossRefGoogle Scholar
  22. 22.
    Merrick GS, Butler WM, Wallner KE et al (2002) Prophylactic versus therapeutic alpha-blockers after permanent prostate brachytherapy. Urology 60:650–655CrossRefGoogle Scholar
  23. 23.
    Yuan J, Liu Y, Yang Z et al (2013) The efficacy and safety of alpha-1 blockers for benign prostatic hyperplasia: an overview of 15 systematic reviews. Curr Med Res Opin 29:279–287CrossRefGoogle Scholar
  24. 24.
    Narayan P, Tunuguntla HS (2005) Long-term efficacy and safety of tamsulosin for benign prostatic hyperplasia. Rev Urol 7(Suppl 4):S42–S48PubMedPubMedCentralGoogle Scholar
  25. 25.
    Chang DF, Campbell JR (2005) Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg 31:664–673CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryUniversity of MichiganAnn ArborUSA
  2. 2.Orthopedic Surgery AssociatesSt. Joseph MercyChelseaUSA
  3. 3.Southern California Permanente Medical GroupBaldwin ParkUSA
  4. 4.Department of Epidemiology, School of Public HealthUniversity of MichiganAnn ArborUSA

Personalised recommendations