A nationwide survey to measure practice variation of catheterisation management in patients undergoing vaginal prolapse surgery.

Department of Obstetrics and Gynaecology, Spaarne Hospital, P.O. Box 770, 2130 AT, Hoofddorp, The Netherlands.
International Urogynecology Journal (Impact Factor: 2.17). 08/2009; 20(7):813-8. DOI: 10.1007/s00192-009-0847-4
Source: PubMed

ABSTRACT Urinary catheterisation following vaginal prolapse surgery causes inconvenience for patients, risk of urinary tract infections and potentially longer hospitalisation. Possibly, practice variation exists concerning diagnosis and management of abnormal postvoid residual (PVR) volume implying suboptimal treatment for certain subgroups.
Nationwide questionnaire-based survey.
Post-operatively, 77% performed transurethral indwelling catheterisation, 12% suprapubic catheterisation and 11% intermittent catheterisation. Catheterisation was applied 3 days (1-7 days) following anterior repair and 1 day (1-3 days) following all other procedures. The median cut-off point for abnormal PVR was 150 mL (range 50-250 mL). Treatment of abnormal PVR consisted mostly of prolonging transurethral indwelling catheterisation for 2 days (range 1-5 days; 57%), 29% by intermittent and 12% by suprapubic catheterisation. Antibiotics were administered by 21% either routinely or based on symptoms only.
Due to insufficient evidence and suboptimal implementation of available evidence, practice variation in catheterisation regimens is high.

  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate whether nitrofurantoin prophylaxis prevents postoperative urinary tract infection (UTI) in patients receiving transurethral catheterization after pelvic reconstructive surgery. In a randomized, double-blind, placebo-controlled trial, participants undergoing pelvic reconstructive surgery were randomized to 100 mg nitrofurantoin or placebo once daily during catheterization if they were: 1) discharged with a transurethral Foley or performing intermittent self-catheterization; or 2) hospitalized overnight with a transurethral Foley. Our primary outcome was treatment for clinically suspected or culture-proven UTI within 3 weeks of surgery. Statistical analysis was performed by χ and logistic regression. Assuming 80% power at a P value of .05, 156 participants were needed to demonstrate a two-thirds reduction in UTI. Of 159 participants, 81 (51%) received nitrofurantoin and 78 (49%) received placebo. There were no significant differences in baseline demographics, intraoperative characteristics, duration and type of catheterization, or postoperative hospitalization, except a lower rate of hysterectomy in the nitrofurantoin group. Nitrofurantoin prophylaxis did not reduce the risk of UTI treatment within 3 weeks of surgery (22% UTI with nitrofurantoin compared with 13% UTI with placebo, relative risk 1.73, 95% confidence interval 0.85-3.52, P=.12). Urinary tract infection treatment was higher in premenopausal women, lower in diabetics, and increased with longer duration of catheterization. In logistic regression adjusting for menopause, diabetes, preoperative postvoid residual volume, creatinine clearance, hysterectomy, and duration of catheterization, there was still no difference in UTI with nitrofurantoin as compared with placebo. Prophylaxis with daily nitrofurantoin during catheterization does not reduce the risk of postoperative UTI in patients receiving short-term transurethral catheterization after pelvic reconstructive surgery.,, NCT01450800. : I.
    Obstetrics and Gynecology 01/2014; 123(1):96-103. · 4.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: There is uncertainty regarding the optimal method of achieving bladder drainage at the time of gynaecologic surgery. As both transurethral catheterization (TUC) and suprapubic catheterization (SPC) have the potential to cause harm, it is important that gynaecologists have accurate evidence upon which to base their bladder drainage policy. Several clinical trials and meta-analyses have compared TUC with SPC in abdominal and pelvic surgery. Most recently, a large meta-analysis pooled the results of 12 gynaecological trials and found that the use of SPC leads to fewer urinary tract infections (UTIs) without any major complications and without increasing the duration of catheterization or length of hospital stay. Robust evidence shows that SPC use leads to fewer UTIs when compared with TUC use in gynaecologic surgery. However, SPC use is associated with an increased incidence of minor complications. Future research should aim to assess the acceptability of both SPC and TUC to patients who are undergoing gynaecologic surgery. The quality of similar data in relation to rectal pelvic surgery is poor in comparison to the data on gynaecologic surgery.
    Current opinion in obstetrics & gynecology 10/2013; 25(5):410-3. · 2.49 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Suprapubic catheterization is commonly used for postoperative bladder drainage after gynecologic procedures. However, recent studies have suggested an increased rate of complications compared with urethral catheterization. We undertook a systematic review and meta-analysis of randomized controlled trials comparing suprapubic catheterization and urethral catheterization in gynecologic populations. PubMed, EMBASE, CINAHL, Google Scholar, and trial registries were searched from 1966 to March 2012 for eligible randomized controlled trials comparing postoperative suprapubic catheterization and urethral catheterization in gynecologic patients. We used these search terms: "catheter," "supra(-)pubic catheter," "urinary catheter," "gyn(a)ecological," "catheterization techniques gyn(a)ecological surgery," "transurethral catheter," and "bladder drainage." No language restrictions were applied. METHODS AND STUDY SELECTION: The primary outcome was urinary tract infection. Secondary outcomes were the need for recatheterization, duration of catheterization, catheter-related complications, and duration of hospital stay. Pooled effect size estimates were calculated using the random effects model from DerSimonian and Laird. In total, 12 eligible randomized controlled trials were included in the analysis (N=1,300 patients). Suprapubic catheterization was associated with a significant reduction in postoperative urinary tract infections (20% compared with 31%, pooled odds ratio [OR] 0.31, 95% confidence interval [CI] 0.185-0.512, P<.01) but an increased risk of complications (29% compared with 11%, pooled OR 4.14, 95% CI 1.327-12.9, P=.01). Complications were mostly related to catheter tube malfunction with no visceral injuries reported. No differences in the rate of recatheterization or hospital stay were demonstrated. Robust patient satisfaction and cost-effectiveness data are lacking. Based on the best available evidence, no route for bladder drainage in gynecologic patients is clearly superior. The reduced rate of infective morbidity with suprapubic catheterization is offset by a higher rate of catheter-related complications and crucially does not translate into reduced hospital stay. As yet, there are insufficient data to determine which route is most appropriate for catheterization; therefore, cost and patient-specific factors should be paramount in the decision. Minimally invasive surgery may alter the requirement for prolonged postoperative catheterization.
    Obstetrics and Gynecology 09/2012; 120(3):678-87. · 4.37 Impact Factor

Full-text (2 Sources)

Available from
May 19, 2014