McPhail MJ, Abu-Hilal M, Johnson CD. A meta-analysis comparing suprapubic and transurethral catheterization for bladder drainage after abdominal surgery

University Surgical Unit, Mail Point 816, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
British Journal of Surgery (Impact Factor: 5.54). 09/2006; 93(9):1038-44. DOI: 10.1002/bjs.5424
Source: PubMed


Although bladder drainage is widely used for general surgical patients undergoing laparotomy, there is little consensus on whether suprapubic or transurethral catheterization is better.
A systematic database search was undertaken to find all studies of suprapubic catheterization. Randomized controlled trials were identified for inclusion. Endpoints for analysis were bacteriuria, patient satisfaction and recatheterization rates. A meta-analysis was performed using fixed-effect or random-effect models as appropriate, depending on heterogeneity.
After abdominal surgery, transurethral catheterization is associated with significant bacteriuria (relative risk (RR)=2.02, P<0.001, 95 percent confidence interval (c.i.) 1.34 to 3.04) and pain or discomfort (RR=2.94, P=0.004, 95 percent c.i. 1.41 to 6.14). Recatheterization rates using the transurethral method were not increased significantly (RR=1.97, P=0.213, 95 percent c.i. 0.68 to 5.74) with heterogeneity between studies.
The suprapubic route for bladder drainage in general surgery is more acceptable to patients and reduces microbiological morbidity.

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    • "Other authors have hypothesized that urethral catheterization may play a role in exacerbating postoperative inflammation at the urethrovesical anastomosis, promoting development of bladder neck or urethral strictures [11]. In a meta-analysis of patients undergoing abdominal surgery (but not RP), postoperative discomfort was significantly higher in patients with urethral versus suprapubic catheterization [12]. "
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