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Evidence summaries

Removal of Short-Term Indwelling Urethral Catheters

Removal of indwelling urethral catheters late at night rather than early in the morning may reduce the number of people who require recatheterisation. Catheter removal after shorter compared to longer durations probably reduces the risk of symptomatic CAUTI (Catheter induced urinary tract infection) and may reduce the risk of dysuria. However, it may lead to more people requiring recatheterisation. Level of evidence: "C"

A Cochrane review [Abstract] 1 included included 99 trials involving 12241 participants. The majority of participants across the trials had undergone some form of surgical procedure.

Thirteen trials involving 1506 participants compared the removal of shortterm indwelling urethral catheters at one time of day (early morning removal group between 6 am to 7 am) versus another (late night removal group between 10 pm to midnight). Catheter removal late at night may slightly reduce the risk of requiring recatheterisation compared with early morning (RR 0.71, 95% CI 0.53 to 0.96; 10 RCTs, 1920 participants). It is uncertain if there is any difference between early morning and late night removal in the risk of developing symptomatic CAUTI (RR 1.00, 95% CI 0.61 to 1.63; 1 RCT, 41 participants; very low‐certainty evidence). We are uncertain whether the time of day makes a difference to the risk of dysuria (RR 2.20; 95% CI 0.70 to 6.86; 1 RCT, 170 participants).

Sixty-eight trials involving 9247 participants compared shorter versus longer durations of catheterisation. Shorter durations may increase the risk of requiring recatheterisation compared with longer durations (RR 1.81, 95% CI 1.35 to 2.41; 44 trials, 5870 participants), but probably reduce the risk of symptomatic CAUTI (RR 0.52, 95% CI 0.45 to 0.61; 41 RCTs, 5759 participants) and may reduce the risk of dysuria (RR 0.42, 95% CI 0.20 to 0.88; 7 RCTs; 1398 participants).

Seven trials involving 714 participants compared policies of clamping catheters versus free drainage. There may be little to no difference between clamping and free drainage in terms of the risk of requiring recatheterisation (RR 0.82, 95% CI 0.55 to 1.21; 5 RCTs; 569 participants). It is uncertain if there is any difference in the risk of symptomatic CAUTI (RR 0.99, 95% CI 0.60 to 1.63; 2 RCTs, 267 participants) or dysuria (RR 0.84, 95% CI 0.46 to 1.54; 1 trial, 79 participants).

Three trials involving 402 participants compared the use of prophylactic alpha blockers versus no intervention or placebo. It is uncertain if prophylactic alpha blockers before catheter removal has any effect on the risk of requiring recatheterisation (RR 1.18, 95% CI 0.58 to 2.42; 2 RCTs, 184 participants) or risk of symptomatic CAUTI (RR 0.20, 95% CI 0.01 to 4.06; 1 trial, 94 participants).

Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison) and by inconsistency (heterogeneity in interventions and outcomes).

    References

    • Ellahi A, Stewart F, Kidd EA et al. Strategies for the removal of short-term indwelling urethral catheters in adults. Cochrane Database Syst Rev 2021;(6):CD004011. [PubMed]

Primary/Secondary Keywords