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Randomized Controlled Trial
. 2022 Aug 1;157(8):667-674.
doi: 10.1001/jamasurg.2022.2205.

Effect of Intraoperative Urinary Catheter Use on Postoperative Urinary Retention After Laparoscopic Inguinal Hernia Repair: A Randomized Clinical Trial

Aldo Fafaj  1 , Emanuele Lo Menzo  2 , Diya Alaedeen  3 , Clayton C Petro  1 , Steven Rosenblatt  1 , Samuel Szomstein  2 , Christian Massier  4 , Ajita S Prabhu  1 , David M Krpata  1 , Walter Cha  5 , Katherine Montelione  1 , Luciano Tastaldi  6 , Hemasat Alkhatib  7 , Samuel J Zolin  1 , Luis Felipe Okida  2 , Michael J Rosen  1
Affiliations
Randomized Controlled Trial

Effect of Intraoperative Urinary Catheter Use on Postoperative Urinary Retention After Laparoscopic Inguinal Hernia Repair: A Randomized Clinical Trial

Aldo Fafaj et al. JAMA Surg. .

Abstract

Importance: Urinary catheters are commonly placed during laparoscopic inguinal hernia repair as a presumed protection against postoperative urinary retention (PUR), one of the most common complications following this operation. Data from randomized clinical trials evaluating the effect of catheters on PUR are lacking.

Objective: To investigate the effect of intraoperative catheters on PUR after laparoscopic inguinal hernia repair.

Design, setting, and participants: This 2-arm registry-based single-blinded randomized clinical trial was conducted at 6 academic and community hospitals in the US from March 2019 to March 2021 with a 30-day follow-up period following surgery. All patients who presented with inguinal hernias were assessed for eligibility, 534 in total. Inclusion criteria were adult patients undergoing laparoscopic, elective, unilateral, or bilateral inguinal hernia repair. Exclusion criteria were inability to tolerate general anesthesia and failure to understand and sign the written consent form. A total of 43 patients were excluded prior to intervention.

Interventions: Patients in the treatment arm had placement of a urinary catheter after induction of general anesthesia and removal at the end of procedure. Those in the control arm had no urinary catheter placement.

Main outcomes and measures: PUR rate.

Results: Of the 491 patients enrolled, 241 were randomized to catheter placement, and 250 were randomized to no catheter placement. The median (IQR) age was 61 (51-68) years, and 465 participants (94.7%) were male. Overall, 44 patients (9.1%) developed PUR. There was no difference in the rate of PUR between the catheter and no-catheter groups (23 patients [9.6%] vs 21 patients [8.5%], respectively; P = .79). There were no intraoperative bladder injuries. In the catheter group, there was 1 incident of postoperative urethral trauma in a patient who presented to the emergency department with PUR leading to a suprapubic catheter placement.

Conclusions and relevance: Intraoperative urinary catheters did not reduce the risk of PUR after laparoscopic inguinal hernia repair. While their use did not appear to be associated with a high rate of iatrogenic complications, there may be a low rate of catastrophic complications. In patients who voided urine preoperatively, catheter placement did not appear to confer any advantage and thus their use may be reconsidered.

Trial registration: ClinicalTrials.gov Identifier: NCT03835351.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Fafaj reported a resident research grant from the Abdominal Core Health Quality Collaborative. Dr Prabhu reported receiving honoraria for speaking and a research grant paid to her institution from Intuitive Surgical and serving on an advisory board and receiving honoraria from Medtronic and Becton, Dickinson and Company. Dr Rosen reported receiving salary support for his role as Medical Director of the Abdominal Core Health Quality Collaborative and grant support paid to his institution from Pacira. No other disclosures were reported.

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References

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