Strategies for the prevention of catheter-related bladder discomfort

Abstract

Background:The ideal measures to prevent postoperative catheter-related bladder discomfort (CRBD) remain unestablished. We conducted the systematic review and meta-analysis to clarify the significance of potential interventions.Methods:We followed the Preferred Reporting Items for Systematic review and Meta-Analysis statement guidelines, and searched databases from MEDLINE, EMBASE, and referred Cochrane Library for randomized clinical trials (RCTs) published before December 2014. Reference lists from reviews or related articles were screened and checked for the related RCTs. Data extraction was performed carefully by 2 authors, respectively, and methodological quality was assessed by scoring system. Meta-analysis was applied for studies using the similar strategies or same reagents on the similar participants focused on CRBD. The primary outcome measure was the incidence of postoperative CRBD.Results:We identified 8 RCTs with interventions ranging from perioperative managements to pharmacological or multicomponent interventions. Meta-analysis showed ketamine was associated with less incidence of CRBD compared with placebo (pool risk ratio [RR] = −0.75, 95% confidence interval [CI] = 0.17–3.44, P < 0.01) at 0 hour, 1 hour (RR = −0.26, 95%CI = −0.38 to −0.13, P < 0.01), and 2 hours (RR = 0.31, 95%CI = 0.17–0.55, P < 0.01) and 6 hours (RR = 0.23, 95% CI = 0.11–0.49, P < 0.01) after operation. Oxybutynin did not affect the incidence of CRBD (RR = 0.46, 95%CI = 0.20–1.03, P = 0.06). Anticholinergic drugs also lower the incidence of CRBD at 0 hour (RR = 0.52, 95% CI = 0.38–0.71, P < 0.01), 1 hour (RR = 0.66, 95% CI = 0.51–0.86, P < 0.01), 2 hours (RR = 0.62, 95% CI = 0.46–0.84, P < 0.01), and 6 hours (RR = 0.56, 95%CI = 0.38–0.81, P < 0.01) postoperatively. Tramadol and gabapentin were also useful in lower the incidence and severity of CRBD in a RCT with 50 patients.Conclusion:The included studies showed great effectiveness in incidence of postoperative CRBD. Meta-analysis supported that ketamine, oxybutynin, and anticholinergic reagents interventions were useful in preventing postoperative catheter-related bladder discomfort.

Effect of Ketorolac on the Prevention of Postoperative Catheter-Related Bladder Discomfort in Patients Undergoing Robot-Assisted Laparoscopic Radical Prostatectomy: A Randomized, Double-Blinded, Placebo-Controlled Study

“…Urinary catheterization is generally used during surgery, although it can cause postoperative catheter-related bladder discomfort (CRBD) [1]. CRBD is characterized by discomfort in the suprapubic region, manifesting as urinary urgency and frequency with or without urge incontinence [1,2]. The incidence of CRBD is 47–90% in patients who have undergone elective surgery [3].…”

“…Opioid and non-opioid analgesics have been administered to 58.9% and 96.5% of patients to manage postoperative pain in general surgery, respectively [10]. However, in contrast to postoperative pain, CRBD has been under-treated and may be resistant to conventional pain management such as opioids because different mechanisms are involved in developing postoperative pain and CRBD [1]. CRBD is induced by involuntary contractions of the urinary bladder mediated by type 3 muscarinic receptor activation [4].…”

“…Agents associated with anti-muscarinic effects, such as tolterodine [11], oxybutynin [12], butylscopolamine [2,13], ketamine [4,14], robinul [15], and dexmedetomidine [6], have been used to prevent and manage CRBD, with varying degrees of success. However, these agents are limited because of various adverse effects, including dry mouth, postoperative nausea and vomiting, facial flushing, and blurred vision [1].…”

The Efficacy of Intraoperative Ketamine-Haloperidol for Prevention of Catheter-related Bladder Discomfort After Lumbar Spinal Stenosis Surgery

“…A systematic review and meta-analysis supported that ketamine, oxybutynin, and some anticholinergic drugs were useful in preventing CRBD. 9…”

Preoperative education with image illustrations enhances the effect of tetracaine mucilage in alleviating postoperative catheter-related bladder discomfort: a prospective, randomized, controlled study

“…CRBD is a common complication after uretheral catheterization in surgical male patients [6], with an incidence ranging from 47 to 90% [3, 23]. It is frequently associated with emergence agitation [3, 4], exacerbated postoperative pain, and other postoperative complications [3, 5].…”