Setting A large training hospital in the Netherlands.Population Patients undergoing anterior colporrhaphy.Methods One hundred patients were included. Patients were randomised into two groups. In one group (n ¼ 50), a transurethral catheter was in place for four days post-operatively and removed on the fifth postoperative day. In the other group (n ¼ 50), catheterisation was not prolonged and the catheter was removed the morning after surgery. Residual volumes after removal of the catheter were measured by ultrasound scanning. Where residual volumes of >200 mL were found the patient was recatheterised for three more days. Urinary cultures were taken before removal of the catheter. Six patients were excluded: four in the standard prolonged catheterisation group and two in the not prolonged catheterisation group. Main outcome measures Need for recatheterisation, urinary tract infection, mean duration of catheterisation and hospital stay. Results Residual volumes exceeding 200 mL and need for recatheterisation occurred in 9% in the standard prolonged catheterisation group versus 40% of patients in the not prolonged catheterisation group (OR 0.15, 95% CI 0.045 -0.47). Positive urine cultures were found in 40% of cases in the standard prolonged catheterisation group compared with 4% in the not prolonged catheterisation group (OR 15, 95% CI 3.2 -68.6). Mean duration of catheterisation was 5.3 days in the standard prolonged catheterisation group and 2.3 days in the not prolonged catheterisation group (P < 0.001). Mean duration of hospitalisation was 7 days in the standard prolonged catheterisation group and 5.7 days in the not prolonged group (P < 0.001). Conclusion The disadvantages of prolonged catheterisation outweigh the advantages, therefore, removal of the catheter on the morning after surgery may be preferable and longer term catheterisation should only be undertaken where there are specific indications.

Sir,Groenen et al. are mistaken to suggest that urinary tract infection should only be diagnosed when symptoms as dysuria, frequency, urgency and suprapubic pain are coexistent with significant bacteriuria. Such complaints are non-specific immediately after prolapse surgery, especially during or after bladder catheterisation.1 Therefore, we decided to measure only the objective outcome of significant bacteriuria.It is also wrong to state that we provide no data of bacteriuria in patients after recatheterisation. We would like to refer to the Materials and methods as well as Table 2, where these are noted.We agree that it would be interesting to find an optimum duration of catheterisation with respect to infection and recatheterisation. We demonstrated in our study that 60% of patients do not need any prolonged catheterisation at all, so that seems to be the optimum for them. In future studies we are focussing on the remaining 40% of patients to identify them immediately after surgery. We will then evaluate if our current protocol of three days prolongation is adequate for such high risk patients. We hope to present these results soon. References1. Tambyah PA, Maki DG. Catheter-associated urinary tract infection is rarely symptomatic. A prospective study of 1497 catheterized patients.