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Meta-Analysis
. 2007 Apr 18;2007(2):CD004011.
doi: 10.1002/14651858.CD004011.pub3.

Strategies for the removal of short-term indwelling urethral catheters in adults

R Griffiths  1 , R Fernandez
Affiliations
Meta-Analysis

Strategies for the removal of short-term indwelling urethral catheters in adults

R Griffiths et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Approximately 15% to 25% of all hospitalised patients have indwelling urethral catheters, mainly to assist clinicians to accurately monitor urine output during acute illness or following surgery, to treat urinary retention, and for investigative purposes.

Objectives: The objective of this review was to determine the best strategies for the removal of catheters from patients with a short-term indwelling urethral catheter. The main outcome of interest was the number of patients who required recatheterisation following removal of indwelling urethral catheter.

Search strategy: We searched the Cochrane Incontinence Group Specialised Register (searched 7 December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2), MEDLINE (January 1966 to 12 July 2006), EMBASE (January 1980 to 12 July 2006), CINAHL (January 1982 to 12 July 2006), Nursing Collection (January 1995 to January 2002) and reference lists of relevant articles and conference proceedings were searched. We also contacted manufacturers and researchers in the field. No language or other restrictions were applied.

Selection criteria: All randomised and quasi-randomised controlled trials (RCTs) that compared the effects of alternative strategies for removal of short-term indwelling urethral catheters on patient outcomes were considered for inclusion in the review.

Data collection and analysis: Eligibility of the trials for inclusion in the review, details of eligible trials and the methodological quality of the trials were assessed independently by two reviewers. Relative risks (RR) for dichotomous data and a weighted mean difference (WMD) for continuous data were calculated with 95% confidence intervals (CI). Where synthesis was inappropriate, trials were considered separately.

Main results: Twenty six trials involving a total of 2933 participants were included in the review. One trial included three treatment groups. In 11 RCTs amongst 1389 people, there was no significant difference in need for recatheterisation, although recatheterisation after removal at night was more likely to be during working hours. Pooled results demonstrated that, following urological surgery and procedures, patients whose indwelling urethral catheters were removed at midnight passed significantly larger volumes at their first void (Difference (fixed) 96 ml; 95% CI 62 to 130). Similar findings were reported for patients following TURP (Difference (fixed) 27; 95% CI 23 to 31). Removal at midnight was also associated with longer time to first void, and shorter lengths of hospitalisation (relative risk of not going home on day of removal = 0.71, 95% CI 0.64 to 0.79). Results in 13 trials amongst 1422 participants having early rather than delayed catheter removal were consistent with a higher risk of voiding problems and a lower risk of infection, with shorter hospitalisation. In three trials involving 234 participants the data were too few to assess differential effects of catheter clamping compared with free drainage prior to withdrawal. No eligible trials compared flexible with fixed duration of catheterisation, or assessed prophylactic alpha sympathetic blocker drugs prior to catheter removal.

Authors' conclusions: There is suggestive but inconclusive evidence of a benefit from midnight removal of the indwelling urethral catheter. There are resource implications but the magnitude of these is not clear from the trials. The evidence also suggests shorter hospital stay after early rather than delayed catheter removal but the effects on other outcomes are unclear. There is little evidence on which to judge other aspects of management, such as catheter clamping.

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Conflict of interest statement

None known

Figures

1.1
1.1. Analysis
Comparison 1 REMOVAL OF IUC AT ONE TIME OF DAY VERSUS ANOTHER TIME OF DAY, Outcome 1 Volume of the first void.
1.2
1.2. Analysis
Comparison 1 REMOVAL OF IUC AT ONE TIME OF DAY VERSUS ANOTHER TIME OF DAY, Outcome 2 Volume of the first void.
1.4
1.4. Analysis
Comparison 1 REMOVAL OF IUC AT ONE TIME OF DAY VERSUS ANOTHER TIME OF DAY, Outcome 4 Time to first void.
1.5
1.5. Analysis
Comparison 1 REMOVAL OF IUC AT ONE TIME OF DAY VERSUS ANOTHER TIME OF DAY, Outcome 5 Time to first void.
1.7
1.7. Analysis
Comparison 1 REMOVAL OF IUC AT ONE TIME OF DAY VERSUS ANOTHER TIME OF DAY, Outcome 7 Length of hospitalization.
1.8
1.8. Analysis
Comparison 1 REMOVAL OF IUC AT ONE TIME OF DAY VERSUS ANOTHER TIME OF DAY, Outcome 8 Removal of catheter to discharge decision.
1.10
1.10. Analysis
Comparison 1 REMOVAL OF IUC AT ONE TIME OF DAY VERSUS ANOTHER TIME OF DAY, Outcome 10 Incidence of recatheterization.
1.11
1.11. Analysis
Comparison 1 REMOVAL OF IUC AT ONE TIME OF DAY VERSUS ANOTHER TIME OF DAY, Outcome 11 IUC not removed on time.
1.12
1.12. Analysis
Comparison 1 REMOVAL OF IUC AT ONE TIME OF DAY VERSUS ANOTHER TIME OF DAY, Outcome 12 Post discharge urinary retention.
1.13
1.13. Analysis
Comparison 1 REMOVAL OF IUC AT ONE TIME OF DAY VERSUS ANOTHER TIME OF DAY, Outcome 13 Post discharge difficulty in passing urine.
1.14
1.14. Analysis
Comparison 1 REMOVAL OF IUC AT ONE TIME OF DAY VERSUS ANOTHER TIME OF DAY, Outcome 14 Post discharge pain when passing urine.
1.15
1.15. Analysis
Comparison 1 REMOVAL OF IUC AT ONE TIME OF DAY VERSUS ANOTHER TIME OF DAY, Outcome 15 Post discharge loin pain.
1.16
1.16. Analysis
Comparison 1 REMOVAL OF IUC AT ONE TIME OF DAY VERSUS ANOTHER TIME OF DAY, Outcome 16 Post discharge fever.
1.17
1.17. Analysis
Comparison 1 REMOVAL OF IUC AT ONE TIME OF DAY VERSUS ANOTHER TIME OF DAY, Outcome 17 Post discharge incontinence.
2.1
2.1. Analysis
Comparison 2 SHORT VERSUS LONGER DURATION OF CATHETER USE, Outcome 1 Short term urinary retention / delayed voiding after catheter removal.
2.2
2.2. Analysis
Comparison 2 SHORT VERSUS LONGER DURATION OF CATHETER USE, Outcome 2 Number needing to be re‐catheterised.
2.3
2.3. Analysis
Comparison 2 SHORT VERSUS LONGER DURATION OF CATHETER USE, Outcome 3 Chronic urinary retention.
2.4
2.4. Analysis
Comparison 2 SHORT VERSUS LONGER DURATION OF CATHETER USE, Outcome 4 Urinary tract infection.
2.5
2.5. Analysis
Comparison 2 SHORT VERSUS LONGER DURATION OF CATHETER USE, Outcome 5 Urinary Tract Infection (by gender).
2.6
2.6. Analysis
Comparison 2 SHORT VERSUS LONGER DURATION OF CATHETER USE, Outcome 6 Urethral pain and discharge.
2.7
2.7. Analysis
Comparison 2 SHORT VERSUS LONGER DURATION OF CATHETER USE, Outcome 7 Secondary haemorrhage.
2.8
2.8. Analysis
Comparison 2 SHORT VERSUS LONGER DURATION OF CATHETER USE, Outcome 8 Deep venous thrombosis.
2.9
2.9. Analysis
Comparison 2 SHORT VERSUS LONGER DURATION OF CATHETER USE, Outcome 9 Epidiymitis.
2.10
2.10. Analysis
Comparison 2 SHORT VERSUS LONGER DURATION OF CATHETER USE, Outcome 10 Recurrence of strictures at 6 months.
2.11
2.11. Analysis
Comparison 2 SHORT VERSUS LONGER DURATION OF CATHETER USE, Outcome 11 Recurrence of strictures at 12 months.
2.12
2.12. Analysis
Comparison 2 SHORT VERSUS LONGER DURATION OF CATHETER USE, Outcome 12 Recurrence of strictures (no time frame).
2.13
2.13. Analysis
Comparison 2 SHORT VERSUS LONGER DURATION OF CATHETER USE, Outcome 13 Long term urinary complications (unspecified).
2.14
2.14. Analysis
Comparison 2 SHORT VERSUS LONGER DURATION OF CATHETER USE, Outcome 14 Post operative fever.
2.15
2.15. Analysis
Comparison 2 SHORT VERSUS LONGER DURATION OF CATHETER USE, Outcome 15 Length of hospitalisation.
2.16
2.16. Analysis
Comparison 2 SHORT VERSUS LONGER DURATION OF CATHETER USE, Outcome 16 Length of hospitalisation.
2.18
2.18. Analysis
Comparison 2 SHORT VERSUS LONGER DURATION OF CATHETER USE, Outcome 18 Patient dissatisfaction.
4.1
4.1. Analysis
Comparison 4 CLAMPING VERSUS FREE DRAINAGE, Outcome 1 Urinary tract infection.
4.2
4.2. Analysis
Comparison 4 CLAMPING VERSUS FREE DRAINAGE, Outcome 2 Urinary retention.
4.3
4.3. Analysis
Comparison 4 CLAMPING VERSUS FREE DRAINAGE, Outcome 3 Number needing to be re‐catheterised.
4.5
4.5. Analysis
Comparison 4 CLAMPING VERSUS FREE DRAINAGE, Outcome 5 Time to first void following removal of IUC.
4.6
4.6. Analysis
Comparison 4 CLAMPING VERSUS FREE DRAINAGE, Outcome 6 Incidence of postoperative voiding dysfunction (by surgery type ).
4.7
4.7. Analysis
Comparison 4 CLAMPING VERSUS FREE DRAINAGE, Outcome 7 Incidence of postoperative dysfunction (by gender).
See this image and copyright information in PMC

Update of

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