Immediate urinary catheter removal after benign non-hysterectomy gynaecological laparoscopic surgery tied to higher risk of urinary retention
A study published in BJOG: An International Journal of Obstetrics & Gynaecology entitled "Immediate versus delayed urinary catheter removal following non-hysterectomy benign gynaecological laparoscopy: a randomised trial" by Lalla McCormack et al. and the team has concluded that there is no reduction in rates of UTI with immediate compared with delayed catheter removal.
They added that Clinicians favouring immediate removal of IDC and earlier discharge should know about the associated increased risk of urinary retention. Patients could be informed that there is approximately a 1 in 12 chance of needing the reinsertion of a urinary catheter for managing retention.
In the present study, a team of researchers compared rates of urinary retention and postoperative urinary tract infection between women with immediate versus women with the delayed removal of the indwelling catheter following benign non-hysterectomy gynaecological laparoscopic surgery. Urinary retention and urinary tract infection were the co-primary outcomes measured in the study.
The secondary outcomes researchers measured in this study were the hospital readmission, analgesia requirements, duration of hospitalisation, and validated bladder function questionnaires.
The study design was a randomised clinical trial (February 2012 and December 2019) with follow-up to 6 weeks and was conducted in two university-affiliated teaching hospitals in Sydney, Australia.
The research could be summarised as:
- A total of 693 women were included, aged 18 years or over.
- These women were undergoing non-hysterectomy laparoscopy for benign gynaecological conditions.
- Conditions like pelvic floor or concomitant bowel surgery were included.
- Three hundred fifty-five participants were randomised to the immediate removal of a urinary catheter and 338 to delayed removal of a urinary catheter.
- There was higher Urinary retention following immediate compared with the delayed urinary catheter removal.
- The urinary tract infection following delayed and immediate removal of the urinary catheter was 7.2 % and 4.7%, respectively. The difference was insignificant.
Concluding further, they said the risk of urinary retention is higher with the immediate than delayed removal of the urinary catheter following benign non-hysterectomy gynaecological laparoscopic surgery.
Though the UTI difference was insignificant, they mentioned.
There is a 1/12 risk of re-catheterisation after immediate urinary catheter removal. It is vital to ensure patients report normal voiding and emptying before discharge to reduce the need for readmission to manage urinary retention.
The major study limitation was related to the loss of follow-up rate, the discrepancy in data, and external validity.
They said, “There is an increasing move towards earlier postoperative discharge. Good postoperative bladder care is an important consideration.”
As acknowledged, the study received financial support from two research grants from the Australasian Gynaecological Endoscopy & Surgery (AGES) Society.
Further reading:
https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.17442
