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Evidence summaries

Urinary Catheter Policies after Urogenital Surgery

To avoid urinary retention it may be beneficial to use postoperative catheterisation, preferably using suprapubic rather than urethral catheter, after urogenital surgery in adults. Urinary tract infections may be fewer when a catheter is removed early. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 39 studies with a total of 3 709 subjects undergoing gynaecological or urological procedures. Studies were generally small and of poor or moderate quality, reporting data on only few outcomes. Confidence intervals were all wide. There was a tendency to a higher risk of (re)catheterisation if a catheter was not used at all postoperatively, but estimate was imprecise of any difference in urinary tract infection (5 trials). Recatheterisation was needed for more patients if a urethral catheter rather than a suprapubic one was used (RR 3.66, 95% CI 1.41 to 9.49; 6 trials). Urinary tract infections were fewer when a catheter was removed earlier (for example 1 versus 3 days, RR 0.50, 95% CI 0.29 to 0.87; 7 trials) with no pattern in respect of catheterisation. Clamp-and-release policy before catheter removal showed a significantly greater incidence of urinary tract infections (RR 4.00, 95% 1.55 to 10.29) and a delay in return to normal voiding (RR 2.50, 95% CI 1.16 to 5.39) compared to immediate catheter removal (1 trial).

Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison) and by limitations in study quality (e.g. poor reporting, inadequate or unclear allocation concealment)

References

  • Phipps S, Lim YN, McClinton S, Barry C, Rane A, N'Dow J. Short term urinary catheter policies following urogenital surgery in adults. Cochrane Database Syst Rev 2006 Apr 19;(2):CD004374. [PubMed]

Primary/Secondary Keywords