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

Hakvoort, R. A.; Thijs, SD; Bouwmeester, FW; Broekman, A.M.W.; Ruhe, IM; Vernooij, M. M. A.; Burger, MP; Emanuel, M.H.; Roovers, JP

doi:10.1111/j.1471-0528.2011.02935.x

Cited by 90 publications

(47 citation statements)

References 24 publications

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“…The organism found most is E. coli followed by Enterococcus sp and Klebsiella pneumoniae . Hakvoort et al [15] demonstrated that patients with transurethral catheters greater than 72 hours were more likely to develop a UTI postoperative after vaginal surgery. Indwelling Foley catheter use may play a role in non- E. coli cultures and may provide an environment that allows growth of certain microorganisms to concentrate [4,16].…”

Section: Discussionmentioning

confidence: 99%

Microbiological Analysis of Urine Cultures in Women after Pelvic Reconstructive Surgery

Dawson

Cramer²,

Thompson³

et al. 2018

Current Urology

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Background/Aims: The rate of urinary tract infection (UTI) after pelvic reconstructive surgery ranges from 9 to 48% and the most common uropathogen is Escherichia coli (E. coli). The aim of the study is to identify the predominant uro-pathogen from urine cultures in women undergoing pelvic reconstructive surgery. Methods: A retrospective review was conducted on women who underwent pelvic reconstructive surgery at a tertiary care center from July 2013 to June 2015. Data was collected from each postoperative visit to evaluate urinary tract symptoms, culture results and treatment in the 3-month postoperative interval. Results: There were 880 cases reviewed (mean age of 59.6 years) during the study period. The most common organism in positive cultures was E. coli after surgery. The total UTI rate was 11.3%. Patients discharged with a Foley catheter had a UTI rate of 65.6% (p = 0.003). Diabetes, neurologic disease, tobacco use, recurrent UTIs and breast or gynecologic cancers had no significant association with UTI after surgery. Conclusion: The most common organism identified is E. coli. Almost 12% of patients will develop a UTI after pelvic reconstructive surgery. The results of this study can influence management of lower urinary tract symptoms in the postoperative period.

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Section: Discussionmentioning

confidence: 99%

Microbiological Analysis of Urine Cultures in Women after Pelvic Reconstructive Surgery

Dawson

Cramer²,

Thompson³

et al. 2018

Current Urology

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“…Indwelling catheters lead to increased rates of UTI compared to intermittent catheterization. In a trial of 87 women undergoing vaginal prolapse repair, patients were randomized to clean intermittent catheterization (CIC) versus indwelling catheter for the management of POUR 32. Women with CIC had significantly less risk of both bactiuria (14% versus 38%, P =0.02) and UTI (12% versus 33%, P =0.03) compared to women with an indwelling catheter.…”

Section: Managementmentioning

confidence: 99%

“…Therefore, transient retention can be expected to resolve spontaneously within 4–6 weeks with the use of some form of bladder drainage to prevent damage to the bladder. Studies have shown the use of an indwelling catheter can actually prolong catheter use by the very fact that bladder function cannot be assessed with an indwelling catheter in place 32,39. Both CIC and SPC methods allow for measurement of PVR while still maintaining bladder drainage.…”

Section: Managementmentioning

confidence: 99%

Prevention and management of postoperative urinary retention after urogynecologic surgery

Geller¹

2014

IJWH

127

116

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Postoperative urinary retention (POUR) is a frequent consequence of gynecologic surgery, especially with surgical correction of urinary incontinence and pelvic organ prolapse. Estimates of retention rates after pelvic surgery range from 2.5%–43%. While there is no standard definition for POUR, it is characterized by impaired bladder emptying, with an elevation in the volume of retained urine. The key to management of POUR is early identification. All patients undergoing pelvic surgery, especially for the correction of incontinence or prolapse, should have an assessment of voiding function prior to discharge. There are several ways to assess voiding function – the gold standard is by measuring a postvoid residual. Management of POUR is fairly straightforward. The goal is to decompress the bladder to avoid long-term damage to bladder integrity and function. The decision regarding when to discontinue catheter-assisted bladder drainage in the postoperative period can be assessed in an ongoing fashion by measurement of postvoid residual. The rate of prolonged POUR beyond 4 weeks is low, and therefore most retention can be expected to resolve spontaneously within 4–6 weeks. When POUR does not resolve spontaneously, more active management may be required. Techniques include urethral dilation, sling stretching, sling incision, partial sling resection, and urethrolysis. While some risk of POUR is inevitable, there are risk factors that are modifiable. Patients that are at higher risk – either due to the procedures being performed or their clinical risk factors – should be counseled regarding the risks and management options for POUR prior to their surgery. Although POUR is a serious condition that can have serious consequences if left untreated, it is easily diagnosed and typically self-resolves. Clinician awareness of the condition and vigilance in its diagnosis are the key factors to successful care for patients undergoing surgical repair.

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“…13 The urological literature demonstrates the superiority of ISC over indwelling catheters and many patients with neurogenic bladder prefer ISC. 2 Previous studies in patients with neurogenic bladder described improved QOL associated with ISC 6 but these benefits seemed to depend on proper patient selection, technique, support and education. 14 Patient noncompliance is associated with complications such as urinary tract infection, epididymitis and urethral trauma along with more severe complications, including bladder perforation or bladder necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…1 ISC is generally considered a simple, painless procedure that obviates complex surgical reconstruction and decreases the complications of indwelling catheters, such as urethral erosion, bladder stones, recurrent infection and cancer. 25 ISC has proved to be well tolerated by patients with chronic neurogenic bladder in whomsimple pharmacological or surgical solutions are not readily available. 6,7 ISC has since been popularized as a conservative means of managing neurogenic bladders, benign prostatic obstruction and bladder neck contracture.…”

mentioning

confidence: 99%

Poor Quality of Life in Patients with Urethral Stricture Treated with Intermittent Self-Dilation

et al. 2014

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Purpose We assessed patient perceptions of regular intermittent self-dilation in men with urethral stricture. Materials and Methods We constructed and distributed a visual analog questionnaire to evaluate intermittent self-dilation via catheterization by men referred for urethral stricture management at a total of 4 institutions. Items assessed included patient duration, frequency, difficulty and pain associated with intermittent self-dilation as well as interference of intermittent self-dilation with daily activity. The primary outcome was patient perceived quality of life. Multivariate analysis was performed to assess factors that affected this outcome. Results Included in the study were 85 patients with a median age of 68 years, a median of 3.0 years on intermittent self-dilation and a median frequency of 1 dilation per day. On a 1 to 10 scale the median intermittent self-dilation difficulty was 5.0 ± 2.7, the median pain score was 3.0 ± 2.7 and median interference with daily life was 2.0 ± 1.3. Overall quality of life in patients with stricture was poor (median score 7.0 ± 2.6 with poor quality of life defined as 7 or greater). On univariate analysis younger age (p <0.01), interference (p = 0.03), pain (p <0.01) and difficulty performing intermittent self-dilation (p = 0.03) correlated with poor quality of life in a statistically significant manner. On multivariate analysis only difficulty catheterizing (p <0.01) and younger age (p = 0.05) were statistically significant predictors. Patients with stricture involving the posterior urethra had a statistically significant increase in difficulty and decrease in quality of life (each p = 0.04). Conclusions Most patients with urethral stricture who are on intermittent selfdilation rate difficulty and pain as moderate, and inconvenience as low but report poor quality of life.

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

Cited by 90 publications

References 24 publications

Microbiological Analysis of Urine Cultures in Women after Pelvic Reconstructive Surgery

Microbiological Analysis of Urine Cultures in Women after Pelvic Reconstructive Surgery

Prevention and management of postoperative urinary retention after urogynecologic surgery

Poor Quality of Life in Patients with Urethral Stricture Treated with Intermittent Self-Dilation

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