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Randomized Controlled Trial
. 2019 May;126(6):804-813.
doi: 10.1111/1471-0528.15580. Epub 2019 Mar 1.

Immediate versus delayed removal of urinary catheter after laparoscopic hysterectomy: a randomised controlled trial

E M Sandberg  1 , Arh Twijnstra  1 , C A van Meir  2 , H S Kok  3 , N van Geloven  4 , K Gludovacz  3 , W Kolkman  5 , Htc Nagel  6 , Lcf Haans  6 , K Kapiteijn  7 , F W Jansen  1   8
Affiliations
Randomized Controlled Trial

Immediate versus delayed removal of urinary catheter after laparoscopic hysterectomy: a randomised controlled trial

E M Sandberg et al. BJOG. 2019 May.

Abstract

Objective: To evaluate if immediate catheter removal (ICR) after laparoscopic hysterectomy is associated with similar retention outcomes compared with delayed removal (DCR).

Study design: Non-inferiority randomised controlled trial.

Population: Women undergoing laparoscopic hysterectomy in six hospitals in the Netherlands.

Methods: Women were randomised to ICR or DCR (between 18 and 24 hours after surgery).

Primary outcome: The inability to void within 6 hours after catheter removal.

Results: One hundred and fifty-five women were randomised to ICR (n = 74) and DCR (n = 81). The intention-to-treat and per-protocol analysis could not demonstrate the non-inferiority of ICR: ten women with ICR could not urinate spontaneously within 6 hours compared with none in the delayed group (risk difference 13.5%, 5.6-24.8, P = 0.88). However, seven of these women could void spontaneously within 9 hours without additional intervention. Regarding the secondary outcomes, eight women from the delayed group requested earlier catheter removal because of complaints (9.9%). Three women with ICR (4.1%) had a urinary tract infection postoperatively versus eight with DCR (9.9%, risk difference -5.8%, -15.1 to 3.5, P = 0.215). Women with ICR mobilised significantly earlier (5.7 hours, 0.8-23.3 versus 21.0 hours, 1.4-29.9; P ≤ 0.001).

Conclusion: The non-inferiority of ICR could not be demonstrated in terms of urinary retention 6 hours after procedure. However, 70% of the women with voiding difficulties could void spontaneously within 9 hours after laparoscopic hysterectomy. It is therefore questionable if all observed urinary retention cases were clinically relevant. As a result, the clinical advantages of ICR may still outweigh the risk of bladder retention and it should therefore be considered after uncomplicated laparoscopic hysterectomy.

Tweetable abstract: The advantages of immediate catheter removal after laparoscopic hysterectomy seem to outweigh the risk of bladder retention.

Keywords: Laparoscopic hysterectomy; urinary catheter; urinary retention.

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Figures

Figure 1
Figure 1
Summary of study flow chart.
Figure 2
Figure 2
Overview of included patients.
See this image and copyright information in PMC

References

    1. Guideline on Minimally Invasive Surgery (in Dutch). [ http://www.anesthesiologie.nl/uploads/openbaar/RL_Minimaal_Invasieve_Chi...]. Accessed 1 October 2017.
    1. Laparoscopic techniques for hysterectomy, interventional procedures guidance. [ https://www.nice.org.uk/guidance/ipg239/resources/laparoscopic-technique...]. Accessed 1 October 2017.
    1. Sandberg EM, Leinweber FS, Herbschleb PJ, Berends‐van der Meer DMA, Jansen FW. Urinary catheterisation management after laparoscopic hysterectomy: a national overview and nurse preference survey. J Obstet Gynaecol 2018;8:1–6. - PubMed
    1. Liang CC, Lee CL, Chang TC, Chang YL, Wang CJ, Soong YK. Postoperative urinary outcomes in catheterized and non‐catheterized patients undergoing laparoscopic‐assisted vaginal hysterectomy – a randomized controlled trial. Int Urogynecol J Pelvic Floor Dysfunct 2009;20:295–300. - PubMed
    1. Ghezzi F, Cromi A, Uccella S, Colombo G, Salvatore S, Tomera S, et al. Immediate Foley removal after laparoscopic and vaginal hysterectomy: determinants of postoperative urinary retention. J Minim Invasive Gynecol 2007;14:706–11. - PubMed

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