Prospective randomized controlled trial of urethral versus suprapubic catheterization

Sethia, Krishna; Selkon, J. B.; Berry, A. R.; Turner, Christine M.; Kettlewell, M. G. W.; Gough, Martin

doi:10.1002/bjs.1800740731

Cited by 93 publications

(64 citation statements)

References 8 publications

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“…necrosis and oedema, causing both prolonged retention and UTI in some patients. However, catheter-induced bacteriuria [32] could be part of the pathogenesis of UTI in these patients, perhaps by facilitating the establishment of a bacterial focus in the necrotic prostate, leading to subsequent recurrent infections. Therefore, it seems reasonable to suggest that the catheter should be removed as soon as possible after treatment.…”

Section: Discussionmentioning

confidence: 99%

Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia

2002

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Objective To compare the efficacy and frequency of complications of transurethral interstitial laser coagulation (ILC) and transurethral microwave thermotherapy (TUMT) with transurethral resection or incision of the prostate (TURP/TUIP) in patients with symptomatic benign prostatic hyperplasia (BPH). Patients and methods Forty-eight patients were randomized to undergo ILC, 46 to TUMT and 24 to TURP/ TUIP; they were followed for 6 months and the outcome analysed on an intention-to-treat basis. Results At 6 months the symptom scores and maximum urinary flow rate (Q max ) had improved significantly in all groups. At 6 months the mean symptom score was 9.2 in both experimental groups and 6.8 in the control group ( P > 0.05); the mean Q max was 20.6 mL/s in the control group, 16.2 in the ILC group ( P > 0.05 vs control) and 13.2 in the TUMT group ( P < 0.05 vs. the control group). In the TUMT group patients developing urinary retention afterward had a significantly greater increase in Q max than those who did not. The types of complications in the three groups varied. Urinary tract infection occurred frequently in the experimental groups, especially after ILC, whereas the 'well-known' complications of TURP occurred in the control group.Overall, 36% in the ILC, 54% in the TUMT and 73% in the control group had no complications (retrograde ejaculation excluded) during the first 6 months. One patient in the TUMT group underwent TURP after 3 months, whereas no patients in the ILC or the control group were re-treated for BPH within the first 6 months. Conclusion In the short term both ILC and TUMT are reasonable alternatives to standard transurethral surgery for symptomatic BPH, where the reduction of symptoms is the primary goal of treatment. However, both ILC and TUMT were associated with morbidity, although the complication profiles differed from those after TURP/TUIP. Both ILC and TUMT seem advantageous in some patients because of the reduced risk of bleeding and the eliminated risk of TUR syndrome, and because TUMT only requires local anaesthesia. Thus, as neither treatment is better in all aspects, the advantages of one technique over the other must be weighed when deciding how to treat each patient.

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Section: Discussionmentioning

confidence: 99%

Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia

2002

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“…Two studies reported a reduction of the urinary tract infection rate from 46 and 49%, respectively, with transurethral catheterization to 8 and 24%, respectively, after suprapubic catheterization [3, 4]. The other studies, however, found no difference [5, 6].…”

Section: Introductionmentioning

confidence: 95%

“…The number of patients to be included in this study was determined based on a decrease in urinary tract infections from 30 to 8%, as reported in a previous trial [3]comparing a transurethral catheter with a suprapubic catheter (superiority design), with a significance level of 5% and a power of 90%. It was calculated that each group should contain at least 62 patients.…”

Section: Methodsmentioning

confidence: 99%

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The Effect of Suprapubic Catheterization versus Transurethral Catheterization after Abdominal Surgery on Urinary Tract Infection: A Randomized Controlled Trial

Baan¹,

Vermeulen²,

Meulen

et al. 2003

Dig Surg

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Background/Aim: Transurethral catheterization is generally associated with a higher incidence of urinary tract infections than suprapubic catheterization; however, suprapubic catheterization is associated with other disadvantages such as higher costs and a more difficult technique, and at the moment there is no consensus about the use of both catheter systems. Therefore, a prospective randomized study was performed to investigate the effects of suprapubic catheterization and transurethral catheterization in patients undergoing surgery on the incidence of urinary tract infections and patient satisfaction. Methods: Patients who underwent an elective laparotomy were randomized and received a suprapubic or transurethral catheter. The primary end point was urinary tract infection. Other parameters of urinary tract infection, as well as duration of catheterization, hospital stay, and number of recatheterizations and of relaparotomies were monitored. Treatment ‘per protocol’ was also analyzed after exclusion of patients receiving another catheter than randomized for. Patients were asked for their satisfaction with the catheters and complaints during and after catheterization. Results: 165 patients were eligible, of whom 19 patients had to be excluded. 75 patients were allocated to receive the suprapubic catheter and 71 the transurethral catheter. There was no difference in the incidence of a urinary tract infection between the suprapubic group (n = 9/75; 12%) and the transurethral group (n = 8/71; 11%). Most patients (6/9) who developed a urinary tract infection in the suprapubic group, however, underwent recatheterization because of postoperative complications/sepsis and relaparotomy. The incidence of urinary tract infections in patients who received a suprapubic catheter and not a transurethral catheter was 3/59 (5%). The patients did not differ with respect to satisfaction and complaints. Being a men, recatheterization and duration of catheterization are risk factors. Conclusions: The incidence of a urinary tract infection between a suprapubic catheter and a transurethral catheter in patients undergoing major surgery was not different. A potential advantage of the suprapubic catheter (reduction of urinary tract infections) is probably partly negated, because transurethral catheters were used if recatheterization was indicated during the postoperative stay or due to complications.

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“…Compared with urethral catheterisation, SPC is associated with a superior quality of life, reduced infection rates and less pain and discomfort. It also enables patients, especially males to attempt normal voiding [2][3][4][5]. There is evidence to suggest that SPC are more acceptable to patients [3,4,6], with one study suggesting that 89% prefer SPC to urethral catheters [1].…”

Section: Introductionmentioning

confidence: 99%

An Unusual Case of Severe Haemorrhage and Small Bowel Injury Following Percutaneous Suprapubic Catheter Insertion

Verwey¹

2012

World J Nephrol Urol

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Suprapubic catheterisation is a useful alternative to urethral catheterisation but it carries potentially serious complications, including bowel injury and infection. We present a case of severe intraabdominal haemorrhage following a suprapubic catheter insertion using the Seldginger technique. The patient's risk of complications was increased by a previous hysterectomy. This case demonstrates the use of ultrasound guidance during suprapubic catheterisation in high risk patients, such as those with previous abdominal or pelvic surgery.

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Prospective randomized controlled trial of urethral versus suprapubic catheterization

Cited by 93 publications

References 8 publications

Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia

Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia

The Effect of Suprapubic Catheterization versus Transurethral Catheterization after Abdominal Surgery on Urinary Tract Infection: A Randomized Controlled Trial

An Unusual Case of Severe Haemorrhage and Small Bowel Injury Following Percutaneous Suprapubic Catheter Insertion

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