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. 2023 Jul 14;7(7):CD013788.
doi: 10.1002/14651858.CD013788.pub2.

Early versus late removal of urinary catheter after kidney transplantation

Michael Goodfellow  1 , Emily R Thompson  1 , Samuel J Tingle  1 , Colin Wilson  1
Affiliations

Early versus late removal of urinary catheter after kidney transplantation

Michael Goodfellow et al. Cochrane Database Syst Rev. .

Abstract

Background: The optimal treatment for end-stage kidney disease is kidney transplantation. During the operation, a catheter is introduced into the bladder and remains in place postoperatively to allow the bladder to drain. This decreases tension from the cysto-ureteric anastomosis and promotes healing. Unfortunately, urinary catheters can pose an infection risk to patients as they allow bacteria into the bladder, potentially resulting in a urinary tract infection (UTI). The longer the catheter remains in place, the greater the risk of developing a UTI. There is no consensus approach to the time a catheter should remain in place post-transplant. Furthermore, the different timings of catheter removal are thought to be associated with different incidences of UTI and postoperative complications, such as anastomotic breakdown.

Objectives: This review aimed to compare patients who had their catheter removed < 5 days post-transplant surgery to those patients who had their catheter removed ≥ 5 days following their kidney transplant. Primary outcome measures between the two groups included: the incidence of symptomatic UTIs, the incidence of asymptomatic bacteriuria and the incidence of major urological complications requiring intervention and treatment.

Search methods: We searched the Cochrane Kidney and Transplant Register of Studies up to 13 April 2023 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal and ClinicalTrials.gov.

Selection criteria: All randomised controlled trials (RCTs) and quasi-RCTs comparing timing of catheter removal post-transplantation were eligible for inclusion. All donor types were included, and all recipients were included regardless of age, demographics or type of urinary catheter used.

Data collection and analysis: Results from the literature search were screened by two authors to identify if they met our inclusion criteria. We designated removal of a urinary catheter before five days (120 hours) as an 'early removal' and anything later than this as a 'late removal.' The studies were assessed for quality using the risk of bias tool. The primary outcome of interest was the incidence of asymptomatic bacteriuria. Statistical analyses were performed using the random effects model, and results were expressed as relative risk (RR) with 95% confidence intervals (CI). Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Main results: Two studies (197 patients) were included in our analysis. One study comprised a full-text article, and the other was a conference abstract with very limited information. The risk of bias in the included studies was generally either high or unclear. It is uncertain whether early versus late removal of the urinary catheter made any difference to the incidence of asymptomatic bacteriuria (RR 0.89, 95% Cl 0.17 to 4.57; participants = 197; I2 = 88%; very low certainty evidence). Data on other outcomes, such as the incidence of UTI and the incidence of major urological complications, were lacking. Furthermore, the follow-up of patients across the studies was short, with no patients being followed beyond one month.

Authors' conclusions: A high-quality, well-designed RCT is required to compare the effectiveness of early catheter removal versus late catheter removal in patients following a kidney transplant. At the present time, there is insufficient evidence to suggest any difference between early and late catheter removal post-transplant, and the studies investigating this were generally of poor quality.

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Conflict of interest statement

  1. Michael Goodfellow: no relevant interests were disclosed

  2. Emily Thompson: no relevant interests were disclosed

  3. Samuel Tingle: no relevant interests were disclosed

  4. Colin Wilson: no relevant interests were disclosed

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 Asymptomatic Bacteriuria, outcome: 1.1 Asymptomatic bacteriuria.
1.1
1.1. Analysis
Comparison 1: Early versus late catheter removal, Outcome 1: Asymptomatic bacteriuria
See this image and copyright information in PMC

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  • doi: 10.1002/14651858.CD013788

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References

References to studies included in this review

Akbarzadehpasha 2014 {published data only}
    1. Akbarzadehpasha A. Influence of time of urinary catheter removal in incidence of asymptomatic bacteriuria in renal transplant recipients [abstract]. International Journal of Urology 2014;21(Suppl 2):A260. [EMBASE: 71768465]
Zomorrodi 2018 {published data only}
    1. Zomorrodi A, Kakei F, Bagheri A, Zomorrodi S, Mohammadrahimi M. Does early removal of Foley's catheter have any influence on infection of recipient post renal transplantation? Is it safe? A randomized clinical trial. Journal of Nephropathology 2018;7(3):122-6. [EMBASE: 622971142]

References to ongoing studies

NCT04815954 {unpublished data only}
    1. NCT04815954. Early vs late urinary catheter removal after renal transplantation. www.clinicaltrials.gov/show/NCT04815954 2021.

Additional references

Akbar 2005
    1. Akbar SA, Jafri SZ, Amendola MA, Madrazo BL, Salem R, Bis KG. Complications of renal transplantation. Radiographics 2005;25(5):1335-56. [MEDLINE: ] - PubMed
Akbari 2017
    1. Akbari R, Rahmani Firouzi S, Akbarzadeh-Pasha A. Old habits die hard; does early urinary catheter removal affect kidney size, bacteriuria and UTI after renal transplantation? Journal of Renal Injury Prevention 2017;6(1):43-8. [MEDLINE: ] - PMC - PubMed
Allareddy 2017
    1. Allareddy V, Rampa S, Rotta AT, Allareddy V. The impact of septicemia occurring during hospitalization for renal transplantation procedures on outcomes in adults in United States. PLoS ONE [Electronic Resource] 2017;12(6):e0179466. [MEDLINE: ] - PMC - PubMed
Baker 2017
    1. Baker RJ, Mark PB, Patel RK, Stevens KK, Palmer N. Renal association clinical practice guideline in post-operative care in the kidney transplant recipient. BMC Nephrology 2017;18(1):174. [MEDLINE: ] - PMC - PubMed
Buttigieg 2018
    1. Buttigieg J, Agius-Anastasi A, Sharma A, Halawa A. Early urological complications after kidney transplantation: an overview. World Journal of Transplantation 2018;8(5):142-9. [MEDLINE: ] - PMC - PubMed
Carmichael 2017
    1. Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L, et al. Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Diseases of the Colon & Rectum 2017;60(8):761-84. [MEDLINE: ] - PubMed
Chughtai 2018
    1. Chughtai SA, Sharma A, Halawa A. Urine leak following kidney transplantation: an evidence-based management plan. Journal of Clinical & Experimental Nephrology 2018;3(3):14. [DOI: 10.29328/journal.jcn.1001018] - DOI
Cole 2007
    1. Cole T, Hakim J, Shapiro R, Kayler LK. Early urethral (Foley) catheter removal positively affects length of stay after renal transplantation. Transplantation 2007;83(7):995-6. [MEDLINE: ] - PubMed
Coussement 2018
    1. Coussement J, Scemla A, Abramowicz D, Nagler EV, Webster AC. Antibiotics for asymptomatic bacteriuria in kidney transplant recipients. Cochrane Database of Systematic Reviews 2018, Issue 2. Art. No: CD011357. [DOI: 10.1002/14651858.CD011357.pub2] - DOI - PMC - PubMed
Cowan 2018
    1. Cowan J, Bennett A, Fergusson N, McLean C, Mallick R, Cameron D, et al. Incidence rate of post-kidney transplant infection: a retrospective cohort study examining infection rates at a large Canadian multicenter tertiary-care facility. Canadian Journal of Kidney Health & Disease 2018;5:2054358118799692. [MEDLINE: ] - PMC - PubMed
Fiorante 2010
    1. Fiorante S, Lopez-Medrano F, Lizasoain Manuel, Lalueza A, Juan RS, Andres A, et al. Systematic screening and treatment of asymptomatic bacteriuria in renal transplant recipients. Kidney International 2010;78(8):774-81. [MEDLINE: ] - PubMed
Fricke 2014
    1. Fricke WF, Maddox C, Song Y, Bromberg JS. Human microbiota characterization in the course of renal transplantation. American Journal of Transplantation 2014;14(2):416-27. [MEDLINE: ] - PubMed
Giral 2002
    1. Giral M, Pascuariello G, Karam G, Hourmant M, Cantarovich D, Dantal J, et al. Acute graft pyelonephritis and long-term kidney allograft outcome. Kidney International 2002;61(5):1880-6. [MEDLINE: ] - PubMed
Glazer 2009
    1. Glazer ES, Akhavanheidari M, Benedict K, James S, Molmenti E. Cadaveric renal transplant recipients can safely tolerate removal of bladder catheters within 48 h of transplant. International Journal of Angiology 2009;18(2):69-70. [MEDLINE: ] - PMC - PubMed
Goldman 2019
    1. Goldman JD, Julian K. Urinary tract infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clinical Transplantation 2019;33(9):e13507. [MEDLINE: ] - PubMed
Gołebiewska 2011
    1. Gołębiewska J, Dębska-Ślizień A, Komarnicka J, Samet A, Rutkowski B. Urinary tract infections in renal transplant recipients. Transplantation Proceedings 2011;43(8):2985-90. [MEDLINE: ] - PubMed
GRADE 2008
    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924-6. [MEDLINE: ] - PMC - PubMed
GRADE 2011
    1. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. Journal of Clinical Epidemiology 2011;64(4):383-94. [MEDLINE: ] - PubMed
Guler 2015
    1. Guler S, Cimen S, Hurton S, Molinari M. Risks and benefits of early catheter removal after renal transplantation. Transplantation Proceedings 2015;47(10):2855-9. [MEDLINE: ] - PubMed
Gustafsson 2012
    1. Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World Journal of Surgery 2012;31(6):783-800. [EMBASE: 369296745] - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557-60. [MEDLINE: ] - PMC - PubMed
Higgins 2022
    1. Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022. Available from www.training.cochrane.org/handbook.
Hill 2007
    1. Hill J, Treasure T. Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients having surgery: summary of NICE guidance. BMJ 2007;334(7602):1053-4. [MEDLINE: ] - PMC - PubMed
Hotta 2017
    1. Hotta K, Miura M, Wada Y, Fukuzawa N, Iwami D, Sasaki H, et al. Atrophic bladder in long-term dialysis patients increases the risk for urological complications after kidney transplantation. International Journal of Urology 2017;24(4):314-9. [MEDLINE: ] - PubMed
Karuthu 2012
    1. Karuthu S, Blumberg EA. Common infections in kidney transplant recipients. Clinical Journal of The American Society of Nephrology: CJASN 2012;7(12):2058-70. [MEDLINE: ] - PubMed
Letica‐Kriegel 2019
    1. Letica-Kriegel AS, Salmasian H, Vawdrey DK, Youngerman BE, Green RA, Furuya EY, et al. Identifying the risk factors for catheter-associated urinary tract infections: a large cross-sectional study of six hospitals. BMJ Open 2019;9(2):e022137. [MEDLINE: ] - PMC - PubMed
Martinez‐Marcos 1994
    1. Martinez-Marcos F, Cisneros J, Gentil M, Algarra G, Pereira P, Aznar J, et al. Prospective study of renal transplant infections in 50 consecutive patients. European Journal of Clinical Microbiology & Infectious Diseases 1994;13(12):1023-8. [MEDLINE: ] - PubMed
Matas 2014
    1. Matas AJ, Smith JM, Skeans MA, Thompson B, Gustafson SK, Schnitzler MA, et al. OPTN/SRTR 2012 Annual Data Report: Kidney. American Journal of Transplantation 2014;14 Suppl 1:11-44. [MEDLINE: ] - PubMed
Miskovic 2017
    1. Miskovic A, Lumb AB. Postoperative pulmonary complications. British Journal of Anaesthesia 2017;118(3):317-34. [MEDLINE: ] - PubMed
Morris 2008
    1. Morris P, Marson LP, Knechtle SJ. Kidney Transplantation: Principles and Practice. 8th edition. Oxford: Elsevier Health Sciences, 2008. [ISBN: 9780323531863]
Nicolle 2014
    1. Nicolle LE. Catheter associated urinary tract infection. Antimicrobial Resistance & Infection Control 2014;3:23. [MEDLINE: ] - PMC - PubMed
Parasuraman 2013
    1. Parasuraman R, Julian K, AST Infectious Diseases Community of Practice. Urinary tract infections in solid organ transplantation. American Journal of Transplantation 2013;13 Suppl 4:327-36. [MEDLINE: ] - PubMed
Pelle 2007
    1. Pellé G, Vimont S, Levy PP, Hertig A, Ouali N, Chassin C, et al. Acute pyelonephritis represents a risk factor impairing long-term kidney graft function. American Journal of Transplantation 2007;7(4):899-907. [MEDLINE: ] - PubMed
Sagalowsky 1983
    1. Sagalowsky AI, Ransler CW, Peters PC, Dickerman PN, Gailiunas P, Helderman JH, et al. Urologic complications in 505 renal transplants with early catheter removal. Journal of Urology 1983;129(5):929-32. [MEDLINE: ] - PubMed
Saint 1999
    1. Saint S, Lipsky BA, Baker PD, McDonald LL, Ossenkop K. Urinary catheters: what type do men and their nurses prefer? Journal of the American Geriatrics Society 1999;47(12):1453-7. [MEDLINE: ] - PubMed
Saint 2006
    1. Saint S, Kaufman SR, Rogers MA, Baker PD, Ossenkop K, Lipsky BA. Condom versus indwelling urinary catheters: a randomized trial. Journal of the American Geriatrics Society 2006;54(7):1055-61. [MEDLINE: ] - PubMed
Schachtner 2017
    1. Schachtner T, Stein M, Reinke P. Sepsis after renal transplantation: clinical, immunological, and microbiological risk factors. Transplant Infectious Disease 2017;19(3):e12695. [MEDLINE: ] - PubMed
Schunemann 2022a
    1. Schünemann HJ, Higgins JP, Vist GE, Glasziou P, Akl EA, Skoetz N, et al. Chapter 14: Completing ‘Summary of findings’ tables and grading the certainty of the evidence. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022. www.training.cochrane.org/handbook.
Schunemann 2022b
    1. Schünemann HJ, Vist GE, Higgins JP, Santesso N, Deeks JJ, Glasziou P, et al. Chapter 15: Interpreting results and drawing conclusions. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022. Available from www.training.cochrane.org/handbook.
Siskind 2013
    1. Siskind E, Sameyah E, Goncharuk E, Olsen EM, Feldman J, Giovinazzo K, et al. Removal of foley catheters in live donor kidney transplant recipients on postoperative day 1 does not increase the incidence of urine leaks. International Journal of Angiology 2013;22(1):45-8. [MEDLINE: ] - PMC - PubMed
SONG 2017
    1. SONG Initiative. The SONG Handbook Version 1.0. www.songinitiative.org/reports-and-publications/ 2017.
Thompson 2018
    1. Thompson ER, Hosgood SA, Nicholson ML, Wilson CH. Early versus late ureteric stent removal after kidney transplantation. Cochrane Database of Systematic Reviews 2018, Issue 1. Art. No: CD011455. [DOI: 10.1002/14651858.CD011455.pub2] - DOI - PMC - PubMed

References to other published versions of this review

Goodfellow 2020
    1. Goodfellow M, Thompson ER, Tingle SJ, Wilson CH. Early versus late removal of urinary catheter after kidney transplantation. Cochrane Database of Systematic Reviews 2020, Issue 11. Art. No: CD013788. [DOI: 10.1002/14651858.CD013788] - DOI - PMC - PubMed

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