BACKGROUND AND PURPOSE:

• The ideal time to remove an indwelling catheter following an uncomplicated laparoscopic hysterectomy is not well understood
  • Risk of retaining catheter: Increased risk for UTI and prolonged hospital stay
  • Benefit of retaining catheter: Less risk for urinary retention
• Sandberg et al. (BJOG, 2019) compared immediate catheter removal (ICR) vs delayed catheter removal (DCR) following laparoscopic hysterectomy

METHODS:

• Non-inferiority randomized controlled trial
• Participants
  • Women undergoing laparoscopic hysterectomy in the Netherlands
  • Uncomplicated surgery
• Groups (randomized)
  • ICR group: Immediate catheter removal post-op
  • DCR group: Delayed catheter removal between 18 and 24 hours post-op
• Primary outcome
  • Urinary retention: Inability to void completely within 6 hours after catheter removal | Retention measured via bladder scan
• Secondary outcomes
  • UTI (based nitrite, leucocytes and clinical symptoms) | time to mobilization (first time out of bed) | Length of hospital stay | Self‐developed questionnaires 6 hours, 24 hours and 6 weeks post-op

RESULTS:

Urinary Retention

• ICR group = 74 | DCR group = 81 women
• ICR was not found to be non-inferior to DCR for primary outcome
  • ICR group with urinary retention: 13.5% (10 women)
  • DCR group with urinary retention: 0%
  • Risk difference: 13.5% (95% CI, 5.6 to 24.8)
• ICR group: Seven of the 10 women voided within 9 hours
• DCR group: 9.9% of women requested catheter removal prior to 18 hours due to discomfort (between 2 to 12 hours)

UTI

• ICR group: 4.1% (3 women)
• DCR group: 9.9% (8 women)
• Risk difference: −5.8% (95% CI, −15.1 to 3.5)

Mobilization

• Women with ICR mobilized significantly earlier (P ≤ 0.001)
• ICR group: 5.7 hours (range, 0.8 to 23.3)
• DCR group: 21.0 hours (range, 1.4 to 29.9)

CONCLUSION:

• Using a non-inferior study design, immediate catheter removal did not prove to be an equivalent option to delayed removal
  • Authors question whether the observed urinary retention cases were clinically relevant considering that 70% of women in the ICR did end up voiding at 9 instead of 6 hours
• Advantages of ICR (e.g., mobilization) may still outweigh the risk of bladder retention following laparoscopic hysterectomy

Learn More – Primary Sources:

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

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