A systematic review and meta-analysis comparing immediate and delayed catheter removal following uncomplicated hysterectomy

Zhang, Peng; Hu, Wanli; Cheng, Bei; Cheng, Lan; Xiong, Xiaokan; Zeng, Yang-Jun

doi:10.1007/s00192-014-2561-0

Cited by 33 publications

(30 citation statements)

References 30 publications

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“…Finally, it is relevant to assess patient's wellbeing on catheter removal. Studies have reported that patients experience more urethral or vesical pain with prolonged catheterisation . In our study, eight women (9.6%) from the DCR group requested catheter removal a few hours after surgery because of unbearable discomfort, which is from a patient's perspective an important finding against prolonged catheterisation.…”

Section: Discussionmentioning

confidence: 70%

“…Studies have reported that patients experience more urethral or vesical pain with prolonged catheterisation. 9 In our study, eight women (9.6%) from the DCR group requested catheter removal a few hours after surgery because of unbearable discomfort, which is from a patient's perspective an important finding against prolonged catheterisation. On the other hand, women who had a catheter in place until the next morning reported on average a low VAS specific for the catheter (2.9, SD 2.9).…”

Section: Discussionmentioning

confidence: 79%

“…[4][5][6] Additionally, patients have reported that they find the indwelling catheter inconvenient. 9,10 On the other hand, immediate removal of the catheter after surgery has been associated with higher rates of urinary retention, which can result in re-catheterisation and other morbidities. Specifically for LH, urinary retention rates of 14%-34% have been reported after immediate removal.…”

Section: Introductionmentioning

confidence: 99%

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Immediate versus delayed removal of urinary catheter after laparoscopic hysterectomy: a randomised controlled trial

Sandberg

Twijnstra

Meir

et al. 2019

BJOG

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Objective To evaluate if immediate catheter removal ( ICR ) after laparoscopic hysterectomy is associated with similar retention outcomes compared with delayed removal ( DCR ). Study design Non‐inferiority randomised controlled trial. Population Women undergoing laparoscopic hysterectomy in six hospitals in the Netherlands. Methods Women were randomised to ICR or DCR (between 18 and 24 hours after surgery). Primary outcome The inability to void within 6 hours after catheter removal. Results One hundred and fifty‐five women were randomised to ICR ( n = 74) and DCR ( n = 81). The intention‐to‐treat and per‐protocol analysis could not demonstrate the non‐inferiority of ICR : ten women with ICR could not urinate spontaneously within 6 hours compared with none in the delayed group (risk difference 13.5%, 5.6–24.8, P = 0.88). However, seven of these women could void spontaneously within 9 hours without additional intervention. Regarding the secondary outcomes, eight women from the delayed group requested earlier catheter removal because of complaints (9.9%). Three women with ICR (4.1%) had a urinary tract infection postoperatively versus eight with DCR (9.9%, risk difference −5.8%, −15.1 to 3.5, P = 0.215). Women with ICR mobilised significantly earlier (5.7 hours, 0.8–23.3 versus 21.0 hours, 1.4–29.9; P ≤ 0.001). Conclusion The non‐inferiority of ICR could not be demonstrated in terms of urinary retention 6 hours after procedure. However, 70% of the women with voiding difficulties could void spontaneously within 9 hours after laparoscopic hysterectomy. It is therefore questionable if all observed urinary retention cases were clinically relevant. As a result, the clinical advantages of ICR may still outweigh the risk of bladder retention and it should therefore be considered after uncomplicated laparoscopic hysterectomy. Tweetable abstract The advantages of immediate catheter removal after laparoscopic hysterectomy seem to outweigh the risk of bladder retention.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

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Immediate versus delayed removal of urinary catheter after laparoscopic hysterectomy: a randomised controlled trial

Sandberg

Twijnstra

Meir

et al. 2019

BJOG

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“…Every attempt is made to remove the catheter for an early trial of void, as this is associated with better infectious outcomes and earlier patient mobilization after surgery. A systematic review and meta‐analysis of early vs delayed catheter removal after uncomplicated hysterectomy showed increased incidence of positive urine culture and symptomatic UTI, as well as a longer time to first ambulation in the delayed removal group . In addition, self‐catheterization is preferred over indwelling catheterization because of lower counts of bacterial colonization .…”

Section: Discussionmentioning

confidence: 99%

Urinary tract infection prevention after midurethral slings in pelvic floor reconstructive surgery: A systematic review and meta‐analysis

Sanaee

Hutcheon

Larouche

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Synthetic midurethral slings are the most common procedures currently performed for stress urinary incontinence in women. Infection is a frequent complication of urogynecologic surgery. We performed a systematic review and meta‐analysis to identify interventions that successfully prevent infections, including urinary tract infection (UTI) and/or bacteriuria, compared with no intervention, in women undergoing midurethral sling surgery with or without concomitant pelvic reconstructive procedures for prolapse. Material and methods The primary outcome was the development of any infection post‐midurethral sling placement in women. MEDLINE, Embase, CINAHL and the Cochrane Library were searched for comparative studies from inception to July 2017, with no language restrictions. We used search terms related to midurethral sling, infections and infection‐reduction interventions. Two independent reviewers abstracted data and assessed study quality. Pooled effect size estimates were calculated. We conducted meta‐analysis of eligible studies. A protocol for this review has been registered and can be accessed online (http://hdl.handle.net/2429/64731). Results We identified seven eligible studies of infection risk‐reducing interventions; all focused on UTIs. Only one study assessed preoperative antibiotics with midurethral sling alone and was halted early because of low UTI rates. All other studies (three randomized control trials and three observational studies) examined whether postoperative antibiotics decrease UTI/bacteriuria rates after midurethral sling with or without reconstructive procedures for pelvic organ prolapse and using bladder catheterization postoperatively. Due to considerable clinical heterogeneity, we only combined four studies for meta‐analysis. Postoperative oral prophylactic nitrofurantoin showed no significant benefit in reducing UTI/bacteriuria in women post‐midurethral sling with or without concomitant reconstructive pelvic surgery and the need for bladder catheterization, when compared with the reference group (pooled relative risk 0.73, 95% confidence interval [CI] 0.42‐1.25). Conclusions Based on the best available evidence, postoperative oral nitrofurantoin is not effective at reducing UTI/bacteriuria rates in catheterized women after midurethral sling with or without concomitant pelvic reconstructive surgery for prolapse. For midurethral sling alone, preoperative antibiotic prophylaxis may not be needed for UTI prevention.

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“…However, studies evaluating the association between these procedures and UTI attributed the relationship to the placement of an in-dwelling catheter during and after surgery. 19,20 The incidence of post-hysterectomy UTI is reported to be increased following delayed catheter removal (24 hours after the procedure). 19 In the present cohort, all patients had undergone catheterization.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors for urinary tract infection following stress urinary incontinence surgery with two midurethral sling procedures

Paz-Levy

Weintraub

Reuven

et al. 2018

Intl J Gynecology & Obste

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A systematic review and meta-analysis comparing immediate and delayed catheter removal following uncomplicated hysterectomy

Abstract: The existing evidence from RCTs suggests that delayed catheter removal following uncomplicated hysterectomy increases the incidence of postoperative bacteriuria and symptomatic UTI but reduces the risk of recatheterization.

Cited by 33 publications

References 30 publications

Immediate versus delayed removal of urinary catheter after laparoscopic hysterectomy: a randomised controlled trial

Immediate versus delayed removal of urinary catheter after laparoscopic hysterectomy: a randomised controlled trial

Urinary tract infection prevention after midurethral slings in pelvic floor reconstructive surgery: A systematic review and meta‐analysis

Prevalence and risk factors for urinary tract infection following stress urinary incontinence surgery with two midurethral sling procedures

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