Early versus delayed removal of indwelling urinary catheter after elective cesarean delivery: systematic review and meta-analysis of randomized controlled trials

Menshawy, Amr; Ghanem, Esraa; Menshawy, Esraa; Masoud, Ahmed Taher; El-Sharkawy, Mohamed; Taher, Ayman; Mahmoud, Mostafa; Khamis, Y.; Haggag, Hisham; Khalifa, Mansour A.; Samy, Ahmed; Abbas, Ahmed M.

doi:10.1080/14767058.2018.1557142

Cited by 15 publications

(9 citation statements)

References 17 publications

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“…From the previous studies, there were five meta-analyses published about intervention for POUR prevention, two studies analyzed about methods and timing of catheterization. 64 , 65 Jackson et al 9 reported not only medical but also non-medical interventions for POUR prevention, including both RCTs and non-RCTs. Clancy et al 66 assessed ALP from five RCTs, particularly in men who underwent inguinal hernia repair.…”

Section: Discussionmentioning

confidence: 99%

Medical and non-medical interventions for post-operative urinary retention prevention: network meta-analysis and risk–benefit analysis

Sirisreetreerux

Wattanayingcharoenchai

Rattanasiri

et al. 2021

Therapeutic Advances in Urology

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Aims: To assess the efficacy in lowering post-operative urinary retention, urinary tract infection and lower urinary tract symptoms and the incidence of adverse events among 12 interventions and to perform risk–benefit analysis. Methods: Previous randomized controlled trials were identified from MEDLINE, Scopus and CENTRAL database up to January 2020. The interventions of interest included early ambulation, fluid adjustment, neuromodulation, acupuncture, cholinergic drugs, benzodiazepine, antispasmodic agents, opioid antagonist agents, alpha-adrenergic antagonists, non-steroidal anti-inflammatory drugs (NSAIDs) and combination of any interventions. The comparators were placebo or standard care or any of these interventions. Network meta-analysis was performed. The probability of being the best intervention was estimated and ranked using rankogram and surface under the cumulative ranking curve. Risk–benefit analysis was done. Incremental risk–benefit ratio (IRBR) was calculated and risk–benefit acceptability curve was constructed. Results: A total of 45 randomized controlled trials with 5387 patients was included in the study. Network meta-analysis showed that early ambulation, acupuncture, alpha-blockers and NSAIDs significantly reduced the post-operative urinary retention. Regarding urinary tract infection and lower urinary tract symptoms, no statistical significance was found among interventions. Regarding the side effects, only alpha-adrenergic antagonists significantly increased the adverse events compared with acupuncture and opioid antagonist agents from the indirect comparison. According to the cluster ranking plot, acupuncture and early ambulation were considered high efficacy with low adverse events, corresponding to the IRBR. Conclusion: Early ambulation, acupuncture, opioid antagonist agents, alpha-adrenergic antagonists and NSAIDs significantly reduce the incidence of post-operative urinary retention with no difference in adverse events. Regarding the risk–benefit analysis of the medical treatment, alpha-adrenergic antagonists have the highest probability of net benefit at the acceptable threshold of side effect of 15%, followed by opioid antagonist agents, NSAIDs and cholinergic drugs.

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Section: Discussionmentioning

confidence: 99%

Medical and non-medical interventions for post-operative urinary retention prevention: network meta-analysis and risk–benefit analysis

Sirisreetreerux

Wattanayingcharoenchai

Rattanasiri

et al. 2021

Therapeutic Advances in Urology

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“…Although each Delivery Unit has its own surgery protocol, the urinary catheter is usually removed up to 24 hours. Whereas there are studies suggesting removing the catheter just after the CS, there are also studies suggesting keeping the catheter until 24 hours after surgery (6)(7)(8)(9). Late removal of the catheter is thought to prevent bladder atony.…”

Section: Introductionmentioning

confidence: 99%

Sezaryen doğumda üriner kateter çıkarma zamanlamasının üriner retansiyona etkisi

Ersak

ELMAS

et al. 2022

Balıkesir Medical Journal

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Objective: In this study, we aimed to compare the postoperative outcomes and urinary retention rate of urinary catheters removed after 6, 12, and 24 hours in cesarean section (CS) patients. Materials and Methods: Pregnant women who had undergone term elective CS for previous CS indication under spinal anesthesia were included in this prospective study. Patients were divided into three groups in a 1:1:1 ratio and the patient’s urinary catheter was removed after 6, 12, and 24 hours. The residual urine amount was calculated with ultrasonography. In addition, the time until ambulation, recatheterization rate, urinary tract infection (UTI) symptoms, and the duration of hospitalization were recorded. Results: The urinary retention rate (13.9 %) was significantly higher in the group whose catheter was removed after 6 hours. The time to the first ambulation was affected by the duration of the catheter and was significantly higher in the group whose catheter was removed after 24 hours (p=0.038). Additionally, dysuria and UTI were seen significantly higher in the group whose catheter was removed after 24 hours. However, the length of hospital stay was similar between the three groups. Conclusion: Considering the benefit-harm balance, removal of the urinary catheter at 12 hours after CS could be suggested. However, the duration of urinary catheter removal should be individualized.

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“…This urodynamic study may portend a better safety profile for the 8-h group; however, this has not been popularized clinically. 8 Interventions like non-urethral catheterization, 3 , 4 immediate removal, 7 2-h removal, 10 6-h removal, 11 , 12 and 24-h removal 1 , 7 after caesarean section are flawed with urine retention morbidity. Immediate or very early removal of urethral catheter may increase the risk of urine retention necessitating the need for recatheterization.…”

Section: Introductionmentioning

confidence: 99%

“…Immediate or very early removal of urethral catheter may increase the risk of urine retention necessitating the need for recatheterization. 4 , 10 , 12 There is currently no consensus on the specific time for removal of urinary catheter post caesarean section. 12 The more the duration of urethral catheter in the urinary bladder, the higher the significant bacteriuria rate and the less incidence of urinary retention following caesarean section under spinal anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

“… 4 , 10 , 12 There is currently no consensus on the specific time for removal of urinary catheter post caesarean section. 12 The more the duration of urethral catheter in the urinary bladder, the higher the significant bacteriuria rate and the less incidence of urinary retention following caesarean section under spinal anaesthesia. 1 , 5 , 7 , 13 , 14 It is therefore necessary to find a balance in the duration of urethral catheterization, which will combine the advantage of reduced bacteriuria rate and lessen the incidence of urinary retention.…”

Section: Introductionmentioning

confidence: 99%

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Eight-hour versus 24-h urethral catheter removal following elective caesarean section for reducing significant bacteriuria: A randomized controlled trial

Igbodike

Awowole

et al. 2021

Womens Health (Lond Engl)

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Background: There is no consensus on the preferred time to remove urethral catheter post caesarean section. Aim: To compare rate of significant bacteriuria and urinary retention following 8-h (study) and 24-h urethral catheter removal (control) post elective caesarean section. Methods: A randomized controlled trial of eligible participants that underwent elective caesarean section under spinal anaesthesia between March 2019 and November 2019 was conducted. Participants (150 in each arm) were randomly assigned (1:1 ratio) to either 8-h or 24-h group. Primary outcome measures included rates of significant bacteriuria 48-h post-operatively and acute urine retention 6-h post urethral catheter removal. Analysis was by Intention-to-treat. ( www.pactr.org:PACTR202105874744483 ) Results: There were 150 participants randomized into each arm and data collection was complete. Significant bacteriuria was less in 8-h group (3% versus 6.0%; risk ratio (RR): 0.85 CI: 0.60 to 5.66; p = 0.274), though not significant. Acute urinary retention requiring repeat catheterisation was significantly higher in 8-h group (11(7.3%) versus 0(0.0%); RR: 0.07; CI: 0.87 to 0.97; p = 0.001). Mean time until first voiding was slightly higher in 8-h group (211.4 ± 14.3 min versus 190.0 ± 18.3 min; mean difference (MD): 21.36; CI: −24.36 to 67.08; p = 0.203); but patient in this group had a lower mean time until ambulation (770.0 ± 26.1 min versus 809 ± 26.2 min; MD: −38.8; CI: −111.6 to 34.0; p = 0.300). The 8-h group were significantly more satisfied (82/150 (54.7%) versus 54/150 (36.0%); p = 0.001) Conclusions: An 8-h group was associated with significant clinical satisfaction and acute urine retention compared to 24-h removal. The timing of urethral catheter removal did not affect rate of significant bacteriuria and other outcomes

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Early versus delayed removal of indwelling urinary catheter after elective cesarean delivery: systematic review and meta-analysis of randomized controlled trials

Cited by 15 publications

References 17 publications

Medical and non-medical interventions for post-operative urinary retention prevention: network meta-analysis and risk–benefit analysis

Medical and non-medical interventions for post-operative urinary retention prevention: network meta-analysis and risk–benefit analysis

Sezaryen doğumda üriner kateter çıkarma zamanlamasının üriner retansiyona etkisi

Eight-hour versus 24-h urethral catheter removal following elective caesarean section for reducing significant bacteriuria: A randomized controlled trial

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