Short term urinary catheter policies following urogenital surgery in adults

Phipps, Simon, Lim, Yik N., McClinton, Samuel, Barry, Chris, Rane, Ajay, and N'Dow, James M.O. (2006) Short term urinary catheter policies following urogenital surgery in adults. Cochrane Database of Systematic Reviews , 2006 (2). CD004374. pp. 1-50.

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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).

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.

Item ID: 4226
Item Type: Article (Research - C1)
ISSN: 1469-493X
Keywords: urinary catheter; incontinence; post-surgical; complications
Date Deposited: 18 Sep 2009 04:32
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1114 Paediatrics and Reproductive Medicine > 111402 Obstetrics and Gynaecology @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920119 Urogenital System and Disorders @ 51%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920118 Surgical Methods and Procedures @ 49%
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