Indwelling Versus Immediate Removal of Transurethral Catheter After Robotic Sacrocolpopexy: A Randomized Clinical Trial

Abstract

Introduction and Hypothesis This study evaluates the necessity and effect of an indwelling transurethral catheter in the early postoperative period following a robotic-assisted laparoscopic sacrocolpopexy. Methods This was a randomized clinical trial of patients who underwent a robotic sacrocolpopexy for pelvic organ prolapse. Patients were randomized to have their transurethral catheter removed 6 hours postoperative (intervention group) or the morning following surgery (control group). Our primary outcome was to compare the number of patients diagnosed with postoperative incomplete bladder empyting in each group. A sample size of 36 patients per group was needed to detect a 25% difference between the 2 groups. Anticipating a 20% patient withdrawal rate, we estimated that we would need a total of 88 participants. Outcome variable was analyzed using χ2 test, Fisher exact test, Mann-Whitney U test, 2-proportions test, and 2-sample t test. Results From December 2015 through May 2017, 88 women were randomized and analyzed: 44 in the intervention group and 44 in the control group. Women in the intervention group were more likely to be diagnosed with incomplete bladder emptying, 14 (31%) of 44, compared with the control group, 2 (4.5%) of 44, P <0.001. Rate of urinary tract infections within the 30-day postoperative period was also increased in the intervention group, 4 (9%) of 44, compared with 0 in the control group. Postoperative complications were similar between groups. Conclusions In women undergoing a robotic sacrocolpopexy, early transurethral catheter removal (6 hours postoperative) is associated with an increased rate of incomplete bladder emptying, recatheterization, and urinary tract infections.

Impact of early postoperative indwelling urinary catheter removal: A systematic review

“…Eight reports were not retrieved, resulting in 102 articles being assessed for eligibility. A total of 20 studies were included in this systematic review (Figure 1), including 13 randomised controlled trials (Ahmed et al, 2014;Aref, 2020;Atilgan et al, 2020;Chai & Pun, 2011;Dunn et al, 2003;El-Mazny et al, 2014;Joshi et al, 2014;Liang et al, 2009;Onile et al, 2008;Ouladsahebmadarek et al, 2012;Sandberg et al, 2019;Sekhavat et al, 2008;Vallabh-Patel et al, 2020) and seven uncontrolled studies (Campbell et al, 2017;Dedden et al, 2020;Duchalais et al, 2019;Hung et al, 2020;Karp et al, 2018;Mengatto et al, 2020;Yoo et al, 2015). Reasons for exclusion were as follows: (a) the use of perioperative epidural anaes-…”

“…& Pun, 2011;Dunn et al, 2003;Joshi et al, 2014;Liang et al, 2009;Sandberg et al, 2019;Vallabh-Patel et al, 2020).…”

“…h and removal the morning after surgery, with 9% and 0% UTIs, respectively(Vallabh-Patel et al, 2020).Eight studies (47%) did not report a significant effect between later removal time and UTIs(Chai & Pun, 2011;Dunn et al, 2003;Hung et al, 2020;Joshi et al, 2014;Mengatto et al, 2020;Onile et al, 2008;Ouladsahebmadarek et al, 2012;Sandberg et al, 2019).One study (6%) did not report a p-value(Dedden et al, 2020).3.5.1 | Re-catheterisationEighteen studies evaluated the re-catheterisation rate after the various postoperative IDUC removal times. In total, five studies (28%) reported a significant result between re-catheterisation and earlier IDUC removal(Ahmed et al, 2014;Aref, 2020;Liang et al, 2009;Sekhavat et al, 2008;Vallabh-Patel et al, 2020).These studies reported a re-catheterisation rate of 16.4%-36% in their earliest removal group compared with 0-6.6% in their latest removal group. Eleven studies did not display a significant relation between re-catheterisation and earlier removal time(Atilgan et al, 2020;Chai & Pun, 2011;Dunn et al, 2003;El- Mazny et al, 2014;Hung et al, 2020;Joshi et al, 2014;Mengatto et al, 2020;Onile et al, 2008;Ouladsahebmadarek et al, 2012;Sandberg et al, 2019;Yoo et al, 2015).…”

A systematic review of best practices for the perioperative management of abdominal sacrocolpopexy

“…Both studies utilized active voiding trials. One RCT found that women who had their catheter removed 6 hours after the robotic ASC were more likely to have urinary retention and UTI compared to women who underwent removal on postoperative day one 35 . Another study of women undergoing pelvic organ prolapse surgery, where the most common procedure was laparoscopic or robotic ASC, investigated whether removing the Foley was possible at 4 hours postoperatively.…”

“…One RCT found that women who had their catheter removed 6 hours after the robotic ASC were more likely to have urinary retention and UTI compared to women who underwent removal on postoperative day one. 35 Another study of women undergoing pelvic organ prolapse surgery, where the most common procedure was laparoscopic or robotic ASC, investigated whether removing the Foley was possible at 4 hours postoperatively. They found the early catheter removal led to decreased time to first spontaneous void, and no significant differences in UTIs, although the sample size was not powered to detect differences.…”