A nationwide survey to measure practice variation of catheterisation management in patients undergoing vaginal prolapse surgery

Abstract

Introduction and hypothesisUrinary catheterisation following vaginal prolapse surgery causes inconvenience for patients, risk of urinary tract infections and potentially longer hospitalisation. Possibly, practice variation exists concerning diagnosis and management of abnormal postvoid residual (PVR) volume implying suboptimal treatment for certain subgroups.MethodsNationwide questionnaire-based survey.ResultsPost-operatively, 77% performed transurethral indwelling catheterisation, 12% suprapubic catheterisation and 11% intermittent catheterisation. Catheterisation was applied 3 days (1–7 days) following anterior repair and 1 day (1–3 days) following all other procedures. The median cut-off point for abnormal PVR was 150 mL (range 50–250 mL). Treatment of abnormal PVR consisted mostly of prolonging transurethral indwelling catheterisation for 2 days (range 1–5 days; 57%), 29% by intermittent and 12% by suprapubic catheterisation. Antibiotics were administered by 21% either routinely or based on symptoms only.ConclusionsDue to insufficient evidence and suboptimal implementation of available evidence, practice variation in catheterisation regimens is high.

Comparing clean intermittent catheterisation and transurethral indwelling catheterisation for incomplete voiding after vaginal prolapse surgery: a multicentre randomised trial

“…We followed the most recent survey and used a cut-off value of 150 ml. 9 Treatment of residual volumes below 300 ml took significantly less time to normalise than treatment of PVRs above 300 ml. We hypothesise that the treatment time for patients with initially low abnormal volumes, below 300 ml, was shorter because the natural course of these PVRs are favourable, and are possibly even self-limiting.…”

“…This period was chosen to reflect common practice in the Netherlands. 9 Furthermore, the comparison of CIC with an additional period of 3 days of catheterisation (TIC) might have been advantageous for CIC, as the duration of treatment in the TIC group was destined to be 3 days, with the possible consequence of a concurrent rise in the rates of bacteriuria and UTI. 10 However, the mean duration for CIC after prolapse surgery in another randomised study was 5 days.…”

“…We defined abnormal PVR as a post-voiding residual volume exceeding 150 ml, measured by bladder scanning. 9 Exclusion criteria were: any neurological or anxiety disorder, or the need for combined antiincontinence surgery. Patients were informed about the study preoperatively and written informed consent was obtained.…”

“…4 Although the inability to adequately empty the bladder is generally short lasting, there is a huge variation in the management of this complication, and many physicians still tend to initially catheterise for several days. 2,3,[5][6][7][8][9] Based on a Cochrane review studying catheter policies after urogenital surgery, and other recent randomised controlled trials studying catherisation specifically after vaginal prolapse surgery, there is an ongoing trend to further restrict the duration of this standard prolonged catheterisation. [1][2][3] However, there is insufficient evidence to tell whether this duration should be 1 day postoperatively or even less.…”

“…The absence of such evidence implies that there are risks of practice variation and the unnecessary prolonging of catheterisation, with consequently higher rates of urinary tract infection (UTI). 9,10 Therefore, a randomised controlled trial was designed in which patients who developed abnormal PVR were randomised between 3-day prolongation of transurethral indwelling catheterisation (TIC) and clean intermittent catheterisation (CIC), performed by nursing staff.…”