Is an indwelling catheter necessary for bladder drainage after modified Burch colposuspension?

Abstract

Catheterization is considered to be a mandatory procedure for adequate bladder drainage following an anti-incontinence operation until the recovery of normal voiding function occurs. We conducted this prospective study to challenge this practice. A total of 86 patients with genuine stress incontinence who underwent a modified Burch coplosuspension were randomized into two groups based on the day of operation. The study group consisted of 42 patients who had the transurethral Foley catheter removed postoperatively the next morning (Group A). The control group was composed of 43 patients who had the transurethral indwelling catheter left in place until the fifth postoperative day (Group B). The percentages of immediate voiding difficulties in Groups A and B were 7.1% and 0%, respectively ( P>0.05). The postoperative urinary tract infection rates of Groups A and B were 16.6% and 23.3%, respectively ( P>0.05). The success rates of our patients were not compromised after our modified operative procedures (78.6% with dry results and 19.0% with improved symptoms in Group A vs. 74.4% with dry results and 20.9% with improved symptoms in Group B, P >0.05). Our results imply that it is not necessary that an indwelling catheter, for bladder drainage, be left in place until the fifth postoperative day to prevent immediate voiding difficulties.

A Systematic Review of Randomized Trials Investigating Methods of Postoperative Void Trials Following Benign Gynecologic and Urogynecologic Surgeries

“…Overall, earlier VT timing showed a shorter time to discharge, shorter time to spontaneous void, shorter duration of catheterization, lower patient burden and lower UTI risk (Table 2). Later VT performance (VT on POD4 and POD5) was associated with lower risk of retention after initial VT 13,[27][28][29] with no difference in timing of VT in proportion discharged home with catheter. The proportion of VT failure was highly variable in between the five studies that looked at this outcome.…”

Is the role of Burch colposuspension fading away in this epoch for treating female urinary incontinence?

“…Fifteen (9.9%) patients complained of inguinal pain after the operation (postcolposuspension syndrome). The median hospital stay was 8 days (range [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The median postoperative bladder training time was 4 days (range 2-11).…”

“…In the meantime, the postoperative hospital stay after Burch colposuspension could be reduced with the early removal of the transurethral catheter [13].…”

“…We modified the Burch operation by making a small incision (no more than 10 cm for Burch procedure) and sutured the paravaginal endopelvic fascia with two pairs of stitches (1-O Ethibond, Johnson & Johnson) along the bladder as described previously in detail by Sun et al [13]. The first sutures were anchored aside the bladder neck with 1 cm between them on each side.…”

The contemporary role of Burch colposuspension

“…Sun et al [11 ] prospectively randomized 86 patients undergoing a Burch urethropexy into urethral catheter removal on postoperative day one versus removal on day five. Although the hospital stay was shorter in the dayone removal group, there were no statistical differences found between the rates of urinary tract infections, postoperative retention, voiding dysfunction, other complications and cure.…”