Early versus delayed urinary catheter removal after hysterectomy: A systematic review and meta-analysis

Postoperative Urinary Complications in Head and Neck Free Flap Reconstructive Surgery

OBJECTIVE

The purpose of this study is to evaluate the postoperative urinary complications and the optimal timing of foley catheter removal in patients who underwent free flap reconstructive surgery for head and neck pathology.

METHODS

A retrospective case-control study of head and neck patients who underwent free flap reconstructive surgery at a single institution between January 2009 and December 2021 was conducted. Patient risk factors for postoperative urinary retention (POUR) were analyzed. Fisher Exact and Wilcoxon Rank Sum tests were used to evaluate rates of foley replacement, straight catheterization, and catheter-associated urinary tract infection (CAUTI) and associated risk factors.

RESULTS

Two hundred and eleven patients were included in this study. Older age, lower BMI, lower intraoperative fluid volumes, and need for straight catheterization were statistically significant for POUR requiring foley replacement. Shorter total (P = .04) and postoperative (P = .01) foley duration showed statistical significance for POUR requiring straight catheterization. About 60% of patients who had straight catheterization required a foley replacement (P < .001). Only one patient (0.5%) developed a urinary tract infection (UTI).

CONCLUSION

Foley catheter duration impacts the risk of POUR requiring straight catheterization and subsequently, foley replacement. Optimal timing for foley catheter removal in the postoperative period remains to be elucidated. Removal of catheters between 21 and 48 hours after surgery may decrease the risk of POUR without increasing the rate of CAUTI in patients with head and neck pathology undergoing free flap reconstructive surgery.

Analysis of the Failure of Removal of the Urinary Catheter for Patients With Intracerebral Hemorrhage Postoperatively

BACKGROUND

We conducted this study to assess the value of clinically relevant data for predicting the failure of removing urinary catheters among patients with intracerebral hemorrhage postoperatively.

MATERIALS AND METHODS

We retrospectively analyzed the medical records of all patients with intracerebral hemorrhage who underwent surgery for removal of intracerebral hematoma between January 2014 and December 2019, all of whom retained their urinary catheter. The patients were classified into 2 groups. Group A included patients who underwent successful removal of the catheter while group B included patients who underwent a failed removal. Univariate analysis was performed to determine the relationship between the failure of catheter removal and the patients' preoperative clinical characteristics. Independent prognostic predictors were identified using multivariate analyses.

RESULTS

The site of intracerebral hematoma ( P =0.004), volume of hematoma ( P <0.001), intraventricular hemorrhage ( P <0.001), admitted Glasgow Coma Scale (GCS) ( P <0.001), GCS before urinary catheter removal ( P <0.001), smoking ( P =0.011), herniation ( P <0.001), urine protein ( P =0.013), creatinine ( P =0.037), and timing of urinary catheter removal ( P <0.001) were significantly different among the 2 groups. Multiple logistical regression analysis indicated that GCS before urinary catheter removal (odds ratio=1.171; 95% confidence interval=1.050-1.306; P =0.005) and timing for urinary catheter removal (odds ratio=0.962; 95% confidence interval=0.944-0.981; P <0.001) were associated with failure of urinary catheter removal.

CONCLUSIONS

This study demonstrated that GCS before urinary catheter removal and the timing of urinary catheter removal are independent factors associated with failure of urinary catheter removal among patients with intracerebral hemorrhage.

Effect of external urinary collection device implementation on female surgical patients

BACKGROUND

The Centers for Disease Control and Prevention reports that catheter-associated urinary tract infections (CAUTIs) are the most common hospital-acquired infection. Female external urinary collection devices (EUCDs) may be an alternative to indwelling urethral catheters (IUCs), thereby decreasing CAUTIs. However, no study has demonstrated that EUCDs can help reduce CAUTIs in female surgical patients. We sought to compare CAUTI rate and the median number of days an IUC was used before and after availability of this female EUCD for surgical patients.

METHODS

A retrospective analysis of adult female surgical patients admitted to a single academic institution who received an IUC and/or EUCD was performed. Patients who received an IUC three months before (PRE) EUCD availability (08/2017-10/2017) were compared to patients receiving an IUC and/or EUCD 12 months after (POST) (11/2017-11/2018).

RESULTS

From 906 surgical patients receiving an IUC/EUCD, 127 received an EUCD in the POST cohort. Compared to the PRE, the POST had a higher rate of CAUTIs (infections per 1000 catheter days, 11.2 vs. 4.6, p = 0.017) and overall UTI rate (infections per 1000 catheter days, 5.4 vs. 4.8, p = 0.036), whereas IUC days were similar between cohorts (median, two vs. two days, p = 0.18). The POST cohort rate of EUCD UTI was 4.6 infections per 1000 device days.

CONCLUSION

While EUCDs appear to be a promising alternative to IUCs for female surgical patients, this study found increased CAUTIs after introduction of an EUCD. Further research is needed to clarify if female EUCDs are effective in decreasing CAUTI prior to widespread adoption.

Effect of urinary catheter removal on different time after hysterectomy: a network meta-analysis

INTRODUCTION AND HYPOTHESIS

The optimal timing for removing urinary catheters is controversial for patients undergoing total hysterectomy. This study aimed to evaluate the optimal time for removing urinary catheters post-hysterectomy.

METHODS

We searched multiple databases from inception till December 31, 2020, for all randomized trials evaluating the timing of catheter removal following hysterectomy. All studies were evaluated by two investigators independently depending on inclusion and exclusion criteria. Network meta-analysis (NMA) was conducted on the data using Stata 14.0 software.

RESULTS

A total of 12 articles involving 1814 patients were ultimately included. This study showed removing urinary catheters 12.1 to 24 h (pooled OR = 2.67; 95% CI, 1.53‑4.67) and 36.1 to 48 h (pooled OR = 8.11;95% CI, 3.78‑17.36) post-hysterectomy increased the risk of urinary tract infection (UTI) compared with immediate catheter removal. Timing of catheter removal in other groups following hysterectomy accompanied a reduced risk of urinary retention (UR) versus immediate catheter removal (P < 0.05). Removal of the urinary catheter from 36.1 to 48 h was most likely to lead to UTI. The maximum SUCRA value of immediate catheter removal after hysterectomy was 99.3% for UR. Catheter removal 24.1 to 36 h after hysterectomy was the best time for preventing UR.

CONCLUSION

Removal of the catheter immediately after hysterectomy may be the optimal time for preventing UTI with increased risk of UR, whereas removal time of the urinary catheters within 6 h post-hysterectomy combined with postoperative urination monitoring might be more beneficial than other removal times following hysterectomy.

Bladder Backfilling versus Standard Catheter Removal for Trial of Void after Outpatient Laparoscopic Gynecologic Surgery: A Systematic Review and Meta-Analysis

OBJECTIVE

To compare the rate of postoperative urinary retention and time to discharge between bladder backfilling and standard catheter removal for trial of void (TOV) after outpatient laparoscopic gynecologic surgery. Our secondary objectives were to compare the time to void, postoperative complications, and patient satisfaction.

DATA SOURCES

We searched the PubMed, Ovid MEDLINE, Embase, Cochrane Library databases, and relevant reference lists of eligible articles up to March of 2021.

METHODS OF STUDY SELECTION

This review included randomized controlled trials (RCTs) of TOV after outpatient laparoscopic gynecologic surgery. Odds ratios (ORs) with 95% confidence interval (CI) and weighted mean differences (WMDs) were reported. The quality of the studies was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. Data were analyzed with Review Manager 5.4 software (RevMan 5.4.1; Cochrane Collaboration, London, United Kingdom).

TABULATION, INTEGRATION, AND RESULTS

Five RCTs (N = 488) were included. The bladder backfilling group had a significantly shorter time to void than the standard TOV group (WMD, -25.19 minutes; 95% CI, -44.60 to -5.77; p = .01). Successful TOV was not significantly different between the 2 (OR, 0.92; 95% CI, 0.51 to -1.65; p = .77), without significant heterogeneity (I² = 24%). There was also no significant difference in the time to discharge between the 2 TOV techniques (WMD, -25.19 minutes; 95% CI, -44.60 to -5.77; p = .01). There was no significant difference in complication rates or patient satisfaction between the 2 groups.

CONCLUSION

The bladder backfilling technique of TOV after outpatient laparoscopic gynecologic surgery may reduce the time to first spontaneous void without affecting patient satisfaction or postoperative complications, but it does not significantly affect the time to discharge or urinary retention.