Objective To evaluate the safety and feasibility of primary unilateral total knee arthroplasty (TKA) without urinary catheterization through pre-operative urination training combined with peri-operative restrictive fluid therapy in an enhanced recovery after surgery (ERAS) program. Methods A retrospective cohort study was carried out to analyze 190 patients who underwent primary unilateral TKA without urinary catheterization through pre-operative urination training combined with peri-operative restrictive fluid therapy during July 2017 to Jan 2019 in China-Japan Friendship Hospital (group A). According to 1:1 matching pair principle, they were matched with another 190 patients who underwent liberal intravenous fluid therapy on the day of surgery with urinary catheterization between Jan 2015 and May 2017 (group B). There were no significant difference in baseline characteristics between both groups (P > 0.05). The primary outcomes were the incidences of post-operative urinary retention, urinary tract infection, urinary irritation symptoms and catheter-related bladder discomfort within 1 month after surgery. Secondary outcomes were length of hospital stay and patient satisfaction in both groups. Results There was no significant difference in terms of postoperative urinary retention (P > 0. 05). The incidence of urinary tract infection, urinary irritation symptoms, catheter-related bladder discomfort, and post-operative hospitalization stay in the group A were significantly less. However, patient satisfaction was meaningfully higher than the group B (P < 0. 05 for all parameters). Conclusion Following ERAS, primary unilateral TKA without urinary catheterization is safety and feasibility, which could reduce the incidence of urinary tract infection, urinary irritation symptoms and catheter-related bladder discomfort. Meanwhile, it did not increase the incidence of post-operative urinary retention. Additionally, this method was able to shorten the post-operative hospitalization stay and improve early patient satisfaction．