Does timing of urinary catheter removal after elective cesarean section affects postoperative morbidity?: a prospective randomized trial

Abstract

Objective: To assess whether immediate (0 h), intermediate (after 6 h), or delayed (after 24 h) removal of an urinary catheter after elective caesarian section (CS) regarding, the rate of urinary retention with recatheterization, rate of symptomatic urinary tract infections (UTI), time of ambulation, and the length of hospital stay.Methods: Prospective randomized controlled trial conducted at King Abd Al-Aziz Hospital, KSA. Two hundred twenty-one women underwent for term elective CS and were randomly allocated into three groups by simple randomization using computer-generated random numbers. Women in group A (73 patients) had their urinary catheter removed immediately after surgery. Group B (81 patients) had the catheter removed 6 h postoperatively while in group C (67 patients) the catheter was removed after 24 h. The following outcomes were assessed for each group: rate of recatheterization, symptomatic UTI, time of ambulation, and the length of hospital stay.Results: All groups were matched regarding maternal age, body mass index, gestational age at delivery, and duration of surgery there was a significantly higher incidence of urinary retention needing recatheterization in the immediate removal group compared to the intermediate and delayed removal groups (13.6 vs. 2.5 and 0%, respectively). Delayed urinary catheter removal was associated with a higher incidence of UTI (13.4%), delayed ambulation time (10.3 h), and longer hospital stay (3.9 days) compared to the early (1.4%, 4.1 h, and 1.9 days, respectively) and intermediate (3.7%, 6.8 h, and 2.4 days respectively) removal groups.Conclusion: Removal of the urinary catheter 6 h postoperatively appears to be more advantageous than early or late removal in cases of CS.

Keywords: Caesarian section; urinary catheter; urinary retention; urinary tract infections.