Short term urinary catheter policies following urogenital surgery in adults

Urinary catheters are often used after urological or gynaecological surgery to check on urine output, to allow patients to pass urine, to allow washing out of the bladder and to help tissues heal. They can be inserted via the urethra (tube between the bladder and the outside) or suprapubically (through the abdomen). Different designs or materials may be used for the catheters, and different ways of managing the catheters and their removal are available. This review assesses the evidence for these options.

Five trials suggested that it might be better to use a catheter after surgery than not to use one as fewer people needed to be re-catheterised if a catheter was used at first. Information from six trials suggested that fewer people needed to be re-catheterised for urinary retention if a suprapubic catheter was used instead of a urethral one. People in up to 11 trials had fewer urinary tract infections if the catheters were removed sooner rather than later.

Although 39 trials were included in the review in total, the evidence in general was poor and came from small studies, which often did not provide enough information to draw firm conclusions. Much larger trials with many more participants must be conducted.

Authors' conclusions: 

Despite reviewing 39 eligible trials, few firm conclusions could be reached because of the multiple comparisons considered, the small size of individual trials, and their low quality. Whether or not to use a particular policy is usually a trade-off between the risks of morbidity (especially infection) and risks of recatheterisation.

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Background: 

Urinary catheterisation (by the urethral or suprapubic routes) is common following urogenital surgery. There is no consensus on how to minimize complications and practice varies.

Objectives: 

To establish the optimal way to manage urinary catheters following urogenital surgery in adults.

Search strategy: 

We searched the Cochrane Incontinence Group specialised trials register (searched 30 May 2005) and the reference lists of relevant articles.

Selection criteria: 

Randomised and quasi-randomised trials were identified. Studies were excluded if they were not randomised or quasi-randomised trials of adults being catheterised following urogenital surgery.

Data collection and analysis: 

Data collection was performed independently by two of the review authors and cross-checked. Where data might have been collected but not reported, clarification was sought from the trialists.

Main results: 

Thirty nine randomised trials were identified for inclusion in the review. They were generally small and of poor or moderate quality reporting data on only few outcomes. Confidence intervals were all wide.

Using a urinary catheter versus not using one
The data from five trials were heterogeneous but tended to indicate a higher risk of (re)catheterisation if a catheter was not used postoperatively. The data gave only an imprecise estimate of any difference in urinary tract infection.

Urethral catheterisation versus suprapubic catheterisation
In six trials, a greater number of people needed to be recatheterised if a urethral catheter rather than a suprapubic one was used following surgery (RR 3.66, 95% CI 1.41 to 9.49).

Shorter postoperative duration of catheter use versus longer duration
In 11 trials, the seven trials with data suggested fewer urinary tract infections when a catheter was removed earlier (for example 1 versus 3 days, RR 0.50, 95% CI 0.29 to 0.87) with no pattern in respect of catheterisation.

Clamp and release policies before catheter removal versus immediate catheter removal
In a single small trial, the clamp-and-release group 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).

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