A comparison of outcomes of transurethral versus suprapubic catheterization after Burch cystourethropexy

Abstract

The objective of this study was to evaluate the outcomes of patients with transurethral vs suprapubic catheterization after Burch cystourethropexy. This is a retrospective cohort study of patients who had an anti-incontinence procedure primarily including Burch cystourethropexy with hysterectomy or Burch alone between July 1997 and June 2002 and comparing the outcomes of transurethral vs suprapubic catheters. The suprapubic and transurethral catheter placed were both 16-Fr Foley catheters. The variables analyzed were length of hospital stay, length of catheterization, postoperative fever, and urinary tract infection. The number of postoperative visits and complications within each group were also compared. Analysis was done utilizing Fisher's exact test and Wilcoxon's rank-sum analysis when indicated. We analyzed the charts of 217 patients. The outcomes of surgery (i.e., blood loss, postoperative morbidity, incidence of urinary tract infection, length of hospital stay) in each group did not statistically differ. There was a significant difference in length of cauterization: 7.1 days for the transurethral group and 9.61 days for the suprapubic group, a 1.79 day difference (p=0.001) and a difference in the number of visits for complaints of pain, 2.5 visits for the suprapubic group, 3.5 visits for the transurethral group (p=0.01). There were no differences in outcomes whether a transurethral or suprapubic catheter was used. There was a significant difference in duration of catheterization and extra visits to the clinic or hospital with a practitioner for the complaint of pain. Patients with a transurethral catheter had on the average one more visit than those with the suprapubic catheter.

Suprapubic Versus Transurethral Catheterization: Perioperative Outcomes After Colpocleisis

“…This difference remained after adjusting for possible confounders such as preoperative PVR, concomitant hysterectomy, and concomitant anti-incontinence surgery. This finding is consistent with a longer length of catheterization found in other studies when comparing SPC with TUC after pelvic reconstructive surgery 10 . The baseline difference in concomitant anti-incontinence procedures and concomitant hysterectomies reflected surgeon preference and was not due to preoperative concerns for voiding function postoperatively.…”

“…Options for managing postoperative transient urinary retention include indwelling transurethral catheter (TUC), clean intermittent catheterization (CIC), and planned suprapubic catheter (SPC) placement at the time of prolapse repair. Each option has unique advantages and disadvantages to include urinary tract infection (UTI) risk, ease of patient use, and patient comfort 7–11 …”

“…Because many women undergoing this procedure would have difficulty performing CIC due to medical comorbidities and challenges with dexterity, options for catheter management are typically limited to either TUC or planned placement of an SPC at the time of surgery. Previous studies examining the risks and benefits between those options after gynecologic surgery have yielded mixed results in terms of UTI risk, with some studies indicating a lower risk with SPC and others indicating similar risk for SPC and TUC 7–10 . In addition, previous studies have shown mixed results regarding length of catheter use postoperatively between the 2 options 9,10 .…”

The contemporary role of Burch colposuspension

“…Their opinion was that shorter catheterization was equivalent if not better. Dunn et al [12] retrospectively reviewed 217 patients who were managed postoperatively with either a suprapubic (106) or a urethral (111) catheter to see if this affected the outcome of the procedure. There were no differences in cure rates and the only statistical differences were with greater pain and shorter length of catheterization in the urethral group.…”

Management of Complicated Urinary Tract Infection

“…Evidence has illustrated that suprapubic catheter may bring more benefits for patients compared to transurethral catheter. A retrospective cohort study showed that patients with suprapubic catheter had less clinical visits due to pain than ones with indwelling urethral catheter [17]. The result from a metaanalysis revealed that suprapubic catheterization was associated with a significant lower risk of bacteriuria and less discomfort compared with transurethral catheter [18].…”