Feasibility of immediate removal of urinary catheter after laparoscopic gynecological surgery for benign diseases: A meta‐analysis of randomized controlled trials

Abstract

Background The proper time for removing the urinary catheter after gynecologic laparoscopy is unclear. Objectives To assess the feasibility of immediate catheter removal after benign gynecologic laparoscopy. Search Strategy PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Wanfang Data were searched from inception to November 30, 2021. Selection Criteria Only randomized controlled trials published in English or Chinese comparing immediate versus delayed catheter removal after gynecologic laparoscopy for benign diseases were included. Data Collection and Analysis The primary outcome was the incidence of postoperative urinary retention (PUR). A random effects model was used to calculate pooled relative risk (RR) and 95% confidence interval (CI). Main Results Six studies were included in this meta‐analysis. There was no significant difference in PUR between immediate and delayed catheter removal (RR 1.51, 95% CI 0.37–6.18), but the evidence was of very low quality. Subgroup analysis according to the type of surgery showed a higher rate of PUR with immediate removal after hysterectomy than after other surgeries. Immediate removal was associated a lower incidence of urinary tract infection and a shorter time to mobilization compared with delayed removal. Conclusions Immediate removal of the urinary catheter is feasible and beneficial after benign gynecologic laparoscopy.

Response: Appropriate timing for the removal of urinary catheter after laparoscopic surgery for benign gynecologic diseases may still be uncertain

“…In these cases, the timing of catheter removal should be individualized. Of course, we acknowledge our findings are inconclusive due to the limited number of included studies and insufficient evidence, especially for the outcomes with LH, as explicitly stated in our study 1 . These limitations call for more well‐designed studies to define the proper timing of catheter removal after LH.…”

“…Of course, we acknowledge our findings are inconclusive due to the limited number of included studies and insufficient evidence, especially for the outcomes with LH, as explicitly stated in our study. 1 These limitations call for more well-designed studies to define the proper timing of catheter removal after LH. Chen et al provide their data regarding the comparison of early (within 6 h after surgery, n = 31) and standard catheter removal (within 12-24 h after surgery, n = 34) after laparoscopic gynecologic surgery, adding to our understanding of the optimal timing of catheter removal after surgery.…”

“…We would like to thank Chen et al for their interest and comments on our study, 1 and we are pleased to discuss these issues. It is well known that the risk of urinary catheter‐related side‐effects such as urinary tract infections (UTIs), patient discomfort, and postoperative pain increases with the duration of indwelling catheterization 2,3 .…”

Feasibility and safety of a non-indwelling urinary catheter after flexible ureteroscopy with intelligent control of renal pelvis pressure: A retrospective study

“…With the advancement of minimally invasive technology and the promotion of the ERAS concept, increasing evidence supports the expedient removal of catheters and the absence of urinary indentations after surgery [13,14]. Due to problems such as high renal pelvic pressure and low lithotripsy e ciency, traditional ureteroscopy is prone to postoperative complications such as infection and bleeding.…”

Letter to the Editor: Appropriate timing for the removal of urinary catheter after laparoscopic surgery for benign gynecologic diseases may still be uncertain

“…We read with great interest the article by Fu et al, 1 suggesting that immediate removal of the urinary catheter is feasible and beneficial after benign gynecologic laparoscopy, based on the results from a meta‐analysis showing that there is no statistically significant difference in rate of postoperative urinary retention (POUR) between immediate and delayed removal of the urinary catheter after benign gynecologic laparoscopy 1 . Additionally, other benefits, such as the decreased risk of urinary tract infection (UTI) are also found in the immediate removal group 1 . The authors comment on the feasibility of “immediate removal of the urinary catheter” in patients after benign laparoscopic surgery.…”