{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T20:09:04Z","timestamp":1792613344033,"version":"4.5.0"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["J Am Acad Orthop Surg","JAAOS"],"published-print":{"date-parts":[[2026,3,15]]},"abstract":"<jats:p>Postoperative urinary retention (POUR), the inability to urinate spontaneously after surgery, affects up to 43% of orthopaedic patients and can lead to pain, bladder injury, urinary tract infections, increased healthcare costs, and delayed rehabilitation. POUR arises from decreased neurologic signaling, reduced bladder sensation and contractility, or mechanical obstruction. Risk factors include advanced age, prior urinary retention, comorbidities (eg, benign prostatic hyperplasia, diabetes, renal dysfunction), anesthesia type, perioperative opioid use, and catheterization. Despite its prevalence, standardized management approaches for POUR are lacking within orthopaedic literature. We propose a structured, evidence-based protocol to be used by orthopaedic surgeons that is centered on specific time and bladder volume thresholds to guide interventions including noninvasive techniques to promote spontaneous voiding, bladder scans, straight catheterization, placement\/removal of indwelling catheters, and urology consultation for persistent POUR. The protocol aims to reduce complications, such as infections and bladder injury, by addressing patient- and procedure-specific risk factors, particularly in high-risk groups such as pediatric patients with neuromuscular conditions and geriatric patients undergoing hip fracture fixation.<\/jats:p>","DOI":"10.5435\/jaaos-d-25-00611","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T21:00:09Z","timestamp":1764795609000},"page":"e787-e796","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Urinary Retention in Orthopaedic Surgery: An Evidence-based Algorithm"],"prefix":"10.5435","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0679-8634","authenticated-orcid":false,"given":"Aaron A.","family":"Olsen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Crawford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad","family":"Pusateri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric D.","family":"Shirley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,11,21]]},"reference":[{"key":"R1-20260413","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1007\/s12630-011-9595-2","article-title":"Risk factors for urinary retention after hip or knee replacement: A cohort study","volume":"58","author":"Griesdale","year":"2011","journal-title":"Can J Anesth"},{"key":"R2-20260413","first-page":"e1900149","article-title":"Incidence, outcomes, and prediction of postoperative urinary retention after a nonurologic procedure","volume":"4","author":"Abdul-Muhsin","year":"2020","journal-title":"J Am Acad Orthop Surg Glob Res Rev"},{"key":"R3-20260413","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.artd.2021.10.009","article-title":"Preoperative factors to assess risk for postoperative urinary retention in total joint arthroplasty: A retrospective analysis","volume":"13","author":"Magaldi","year":"2022","journal-title":"Arthroplasty Today"},{"key":"R4-20260413","doi-asserted-by":"crossref","first-page":"e2422281","DOI":"10.1001\/jamanetworkopen.2024.22281","article-title":"Urinary retention evaluation and catheterization algorithm for adult inpatients","volume":"7","author":"Chrouser","year":"2024","journal-title":"JAMA Netw Open"},{"key":"R5-20260413","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.1016\/j.spinee.2021.05.009","article-title":"Risk factors for postoperative urinary retention following elective spine surgery: A meta-analysis","volume":"21","author":"Chang","year":"2021","journal-title":"Spine J"},{"key":"R6-20260413","doi-asserted-by":"crossref","first-page":"2309499020905134","DOI":"10.1177\/2309499020905134","article-title":"Urinary retention after total joint arthroplasty of hip and knee: Systematic review","volume":"28","author":"Cha","year":"2020","journal-title":"J Orthop Surg (Hong Kong)"},{"key":"R7-20260413","doi-asserted-by":"crossref","first-page":"S52","DOI":"10.1016\/j.arth.2023.02.040","article-title":"Routine use of bladder scans after primary total joint arthroplasty is not necessary: Results of a protocol change","volume":"38","author":"Magnuson","year":"2023","journal-title":"J Arthroplasty"},{"key":"R8-20260413","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1186\/s13018-019-1360-1","article-title":"Would early removal of indwelling catheter effectively prevent urinary retention after hip fracture surgery in elderly patients?","volume":"14","author":"Kwak","year":"2019","journal-title":"J Orthop Surg Res"},{"key":"R9-20260413","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1186\/s12877-024-05101-2","article-title":"Risk factors for postoperative urinary retention in fragility hip fracture patients: A prospective study","volume":"24","author":"Tantigate","year":"2024","journal-title":"BMC Geriatr"},{"key":"R10-20260413","doi-asserted-by":"crossref","first-page":"443","DOI":"10.5435\/JAAOS-D-21-00963","article-title":"Postoperative urinary retention in modern rapid recovery total joint arthroplasty","volume":"30","author":"Bracey","year":"2022","journal-title":"J Am Acad Orthop Surg"},{"key":"R11-20260413","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1002\/bjs5.50114","article-title":"Systematic review of interventions for the prevention and treatment of postoperative urinary retention: Prevention and treatment of postoperative urinary retention","volume":"3","author":"Jackson","year":"2019","journal-title":"BJS Open"},{"key":"R12-20260413","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s13741-020-00167-z","article-title":"Postoperative urinary retention: Risk factors, bladder filling rate and time to catheterization: An observational study as part of a randomized controlled trial","volume":"10","author":"Brouwer","year":"2021","journal-title":"Perioper Med"},{"key":"R13-20260413","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1089\/sur.2020.159","article-title":"Outcomes after early versus delayed urinary bladder catheter removal after proctectomy for benign and malignant disease in 2,429 patients: An observational cohort study","volume":"22","author":"Hung","year":"2021","journal-title":"Surg Infections"},{"key":"R14-20260413","doi-asserted-by":"crossref","first-page":"e900","DOI":"10.5435\/JAAOS-D-19-00778","article-title":"\u201cOutpatient\u201d\u2014Same-calendar-day discharge hip and knee arthroplasty","volume":"28","author":"Scully","year":"2020","journal-title":"J Am Acad Orthop Surg"},{"key":"R15-20260413","doi-asserted-by":"crossref","first-page":"29","DOI":"10.36469\/jheor.2024.121641","article-title":"Economic impact of postoperative urinary retention in the US hospital setting","volume":"11","author":"Wang","year":"2024","journal-title":"J Health Econ Outcomes Res"},{"key":"R16-20260413","doi-asserted-by":"crossref","DOI":"10.5435\/JAAOS-D-24-00682","article-title":"Catheterizations Reduced Following a Protocol Change for Postoperative Urinary Retention Following Total Joint Arthroplasty With Spinal Anesthesia","author":"Kohring","year":"2025","journal-title":"J Am Acad Orthop Surg"},{"key":"R17-20260413","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5313\/wja.v8.i1.1","article-title":"Post-operative urinary retention: Review of literature","volume":"8","author":"Agrawal","year":"2019","journal-title":"WJA"},{"key":"R18-20260413","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1097\/ALN.0b013e31819f7aea","article-title":"Postoperative urinary retention: Anesthetic and perioperative considerations","volume":"110","author":"Baldini","year":"2009","journal-title":"Anesthesiology"},{"key":"R19-20260413","article-title":"Statistics about diabetes. Diabetes.org","year":"2023","journal-title":"Am Diabetes Assoc"},{"key":"R20-20260413","doi-asserted-by":"crossref","first-page":"613216","DOI":"10.1155\/2015\/613216","article-title":"What are the risk factors associated with urinary retention after orthopaedic surgery?","volume":"2015","author":"Sung","year":"2015","journal-title":"Biomed Res Int"},{"key":"R21-20260413","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.3760\/cma.j.issn.0366-6999.20132407","article-title":"Diabetic bladder dysfunction","volume":"127","author":"Liu","year":"2014","journal-title":"Chin Med J (Engl)"},{"key":"R22-20260413","doi-asserted-by":"crossref","first-page":"e507","DOI":"10.3928\/01477447-20150603-59","article-title":"Risk factors for postoperative urinary retention in men undergoing total hip arthroplasty","volume":"38","author":"Hollman","year":"2015","journal-title":"Orthopedics"},{"key":"R23-20260413","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/j.arth.2015.09.007","article-title":"Urinary retention is rare after total joint arthroplasty when using opioid-free regional anesthesia","volume":"31","author":"Tischler","year":"2016","journal-title":"J Arthroplasty"},{"key":"R25-20260413","doi-asserted-by":"crossref","first-page":"S343","DOI":"10.1016\/j.arth.2019.03.015","article-title":"Identifiable risk factors to minimize postoperative urinary retention in modern outpatient rapid recovery total joint arthroplasty","volume":"34","author":"Ziemba-Davis","year":"2019","journal-title":"J Arthroplasty"},{"key":"R26-20260413","doi-asserted-by":"crossref","first-page":"455","DOI":"10.2106\/JBJS.N.00662","article-title":"General compared with spinal anesthesia for total hip arthroplasty","volume":"97","author":"Basques","year":"2015","journal-title":"J Bone Joint Surg"},{"key":"R27-20260413","doi-asserted-by":"crossref","first-page":"3748","DOI":"10.1016\/j.arth.2017.07.009","article-title":"Incidence and risk factors for postoperative urinary retention in total hip arthroplasty performed under spinal anesthesia","volume":"32","author":"Lawrie","year":"2017","journal-title":"J Arthroplasty"},{"key":"R28-20260413","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.arth.2018.08.042","article-title":"The Most significant risk factors for urinary retention in fast-track total joint arthroplasty are iatrogenic","volume":"34","author":"Halawi","year":"2019","journal-title":"J Arthroplasty"},{"key":"R29-20260413","doi-asserted-by":"crossref","first-page":"312","DOI":"10.2106\/JBJS.22.00759","article-title":"Short-term indwelling foley catheters do not reduce the risk of postoperative urinary retention in uncomplicated primary THA and TKA: A randomized controlled trial","volume":"105","author":"Weintraub","year":"2023","journal-title":"J Bone Joint Surg Am"},{"key":"R30-20260413","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.arth.2014.09.028","article-title":"General anesthesia: To catheterize or not? A prospective randomized controlled study of patients undergoing total knee arthroplasty","volume":"30","author":"Huang","year":"2015","journal-title":"J Arthroplasty"},{"key":"R31-20260413","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1136\/bmjqs-2018-008025","article-title":"Michigan appropriate perioperative (MAP) criteria for urinary catheter use in common general and orthopaedic surgeries: Results obtained using the RAND\/UCLA appropriateness method","volume":"28","author":"Meddings","year":"2019","journal-title":"BMJ Qual Saf"},{"key":"R32-20260413","doi-asserted-by":"crossref","first-page":"e1299","DOI":"10.5435\/JAAOS-D-23-01211","article-title":"Efficacy and safety of catheter interventions for postoperative urinary retention after primary hip and knee total joint arthroplasty","volume":"32","author":"Evans","year":"2024","journal-title":"J Am Acad Orthop Surg"},{"key":"R33-20260413","doi-asserted-by":"crossref","first-page":"229","DOI":"10.3171\/2016.8.SPINE151371","article-title":"Postoperative urinary retention in patients undergoing elective spinal surgery","volume":"26","author":"Altschul","year":"2017","journal-title":"J Neurosurg Spine"},{"key":"R34-20260413","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1159\/000350943","article-title":"Urinary retention: Benefit of gradual bladder decompression\u2014Myth or truth? A randomized controlled trial","volume":"91","author":"Boettcher","year":"2013","journal-title":"Urol Int"},{"key":"R35-20260413","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/ajhp\/zxac349","article-title":"Tamsulosin for prevention of postoperative urinary retention: A systematic review and meta-analysis","volume":"80","author":"Baysden","year":"2023","journal-title":"Am J Health Syst Pharm"},{"key":"R36-20260413","first-page":"CD006015","article-title":"Finasteride for benign prostatic hyperplasia","volume":"2015","author":"Tacklind","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"R37-20260413","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.3390\/children9101488","article-title":"Postoperative urinary retention after pediatric orthopedic surgery","volume":"9","author":"Belthur","year":"2022","journal-title":"Children"},{"key":"R38-20260413","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1016\/j.jpedsurg.2017.09.023","article-title":"Postoperative urinary retention or difficulties to empty the bladder in young patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis","volume":"53","author":"Keskinen","year":"2018","journal-title":"J Pediatr Surg"},{"key":"R39-20260413","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/0090-4295(83)90079-1","article-title":"Estimating bladder capacity in children","volume":"21","author":"Koff","year":"1983","journal-title":"Urology"}],"container-title":["Journal of the American Academy of Orthopaedic Surgeons"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.5435\/JAAOS-D-25-00611","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T14:51:18Z","timestamp":1787669478000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.5435\/JAAOS-D-25-00611"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,21]]},"references-count":38,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.5435\/jaaos-d-25-00611","relation":{},"ISSN":["1067-151X","1940-5480"],"issn-type":[{"value":"1067-151X","type":"print"},{"value":"1940-5480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,21]]},"assertion":[{"value":"2025-05-12","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-19","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}