Evaluation of the use vs nonuse of urinary catheterization during cesarean delivery: a prospective, multicenter, randomized controlled trial

Abstract

Objective: To prospectively investigate the effects on urinary tract infection (UTI) of indwelling urinary catheter placement during cesarean delivery.Study Design: Randomized controlled trial.Result: There were no significant differences between the two groups regarding patient demographics. There was, however, a statistically significant increase in women using general anesthesia in the catheterized group (CG). Even so, the incidence of UTI was significantly greater in the CG (P<0.001). In addition, mean time to patient ambulation, first postoperative voiding, oral rehydration, intestinal movement and duration of hospital stay were significantly less in the uncatheterized group (UG; P<0.001), with most patients (95.3%) selfvoiding without any intervention. Moreover, no intraoperative complications were recorded in the UG.Conclusion: Non-placement of indwelling urinary catheter during cesarean was more convenient to women with no increase in intraoperative complications, or urinary retention. Indwelling catheter placement in hemodynamically stable patients proved not to be beneficial in this study.

Caesarean Section Without Using Bladder Catheterization Is Safe in Uncomplicated Patients

“…Only one case of UG developed bladder distension at the end of surgery. This finding is similar to other studies [9,4]. The low rate of urinary bladder distension detected in our study may be related to short operation time as well as to voiding immediately before operation.…”

“…It is observed in this study that patients with noncatheterized urinary bladder (UG) initiated ambulation significantly earlier than those in CG, similar to other studies [4,9,10]. It is likely that early ambulation could be attributed to the absence of urinary catheter, which restricts patients' movements, and fear of accidental expulsion [12].…”

“…Consequently, the intraoperative difficulty was not seen and the operative field was easily exposed after retraction of the urinary bladder with Doyen's retractor. Even when the bladder distension develops at the start of surgery, we support Nasre et al argument that a slightly filled bladder may be better demarcated and therefore, more easily identified intraoperatively [9].…”

“…Only one patient developed urinary retention (2%), similar to other studies [9,4], but much lower than the observed Is Safe in Uncomplicated Patients range of 3.3 -39.2% [17]. It is reported that the low rate of postoperative urine retention among UG could be the result of adequate analgesia, early ambulation and re catheterization in UG when needed [18,7,9,4].…”

“…This finding is comparable to Pandey D (2015) who found among 75 women assigned for catheterization that the incidence of UTI detected by urine culture was 29.3% compared to 4% of UG, (P < 0.005) [10], but higher than that reported by Nasre AM et al [9] who found the incidence of UTI among catheterized women (n = 210) by simple urine analysis as 5.7% and 2.9% after 24 h and 1 week respectively. This could be explained by small sample size of our study.…”