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: 1.96). 08/2009; 20(7):813-8. DOI: 10.1007/s00192-009-0847-4
Source: PubMed


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.

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Available from: Mark Hans Emanuel
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    • "After vaginal prolapse surgery with anterior colporraphy, it is common to use an indwelling catheter for several days in order to prevent overdistention of the bladder. In literature, duration of catheterization varies from 3 h to 7 days [1–3]. The benefit of short-term catheterization could be a reduction of hospital stay and urinary tract infections. "
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    ABSTRACT: For prolonged catheterization after vaginal prolapse surgery with anterior colporrhaphy, the optimal duration to prevent overdistention of the bladder remains unknown. We designed this study to determine the optimal length of catheterization. We conducted a prospective randomized trial in which 179 women were allocated to 1-day or 3-day suprapubic catheterization. The primary outcome was the duration of catheterization. Mean duration of catheterization and hospital stay was significantly shorter in the 1-day catheterization group. The number of successful voiding trials was higher in the 3-day catheterization group (90.9% versus 79.3%), but this did not reach statistical significance. The percentage of urinary tract infection did not differ significantly between the groups (4.5% versus 2.4%). Starting a voiding trial 1 day after vaginal prolapse surgery leads to shorter duration of catheterization and hospital stay.
    Full-text · Article · Mar 2011 · International Urogynecology Journal
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    • "A nationwide questionnaire-based survey in 99 hospitals in The Netherlands has shown a mean duration of catheterization of 3.7 days (1–7 days) following an anterior colporrhaphy [1]. Drainage of urine is being performed to reduce the risk of retention by postoperative edema of the bladder. "
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    ABSTRACT: The aim of this study was to compare the number of temporary catheter replacements and urinary tract infections after indwelling catheterization for 2 versus 5 days following an anterior colporrhaphy. Two hundred forty-six patients were randomly assigned to 2 or 5 days of indwelling catheterization. Outcome measures were temporary catheter replacements because of post-voiding residual >200 mL after removal of the indwelling catheter, urinary tract infections, and hospital stay. All patients were analyzed according to the intention to treat principle. Compared to the 5-day protocol group, in the 2-day protocol group more patients needed temporary catheter replacement (9% versus 28%, odds ratio (OR) 4.0, confidence interval (CI) 1.9-8.3, p < 0.01), whereas less patients had a urinary tract infection (37% versus 22%, OR 0.5, CI 0.3-0.9, p = 0.02) and median hospital stay was lower. Removal of an indwelling catheter after 2 versus 5 days following anterior colporrhaphy is associated with more temporary catheter replacements, but less urinary tract infections and a shorter hospital stay.
    Full-text · Article · Oct 2010 · International Urogynecology Journal
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    ABSTRACT: To compare the effect of suprapubic and transurethral catheterization on postvoid residual volumes (PRVs) after cystocele repair. 126 women who underwent pelvic organ prolapse surgery including cystocele repair were randomized to suprapubic or transurethral catheterization. At the third postoperative day, PRVs were measured. The number of women with PRV >150 ml, need for prolonged catheterization, recatheterization, length of hospital stay, frequency of urinary tract infections and complications were determined. PRVs exceeded 150 ml in 13 out of 64 (20%) and 14 out of 62 (23%) women in the suprapubic and transurethral group, respectively (p = 0.76). In the suprapubic group a higher rate of urine leakage was noted (27 vs. 7%, p = 0.003). 10 women (16%) allocated to the suprapubic group switched to transurethral catheterization, because of problems with the suprapubic catheter. No protocol deviations were reported in the transurethral group. Of the women in both groups, 9% developed urinary tract infections (p = 0.93). Suprapubic catheterization was comparable to transurethral catheterization in the prevention of postoperative voiding dysfunction after vaginal prolapse surgery, but it was associated with a higher rate of complications.
    No preview · Article · Feb 2011 · Gynecologic and Obstetric Investigation
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