Urinary Catheter Management Approaches Among Women Undergoing Benign Gynecologic Surgery: A Randomized Trial

Abstract

Objective The objective of this study was to identify differences in voiding trial success rates between delayed (postoperative day 1) and day of surgery catheter removal (“fast track”) among women undergoing benign gynecologic surgery. Rates of urinary tract infection, patient satisfaction, and lower urinary tract symptoms were compared between catheter management schemes. Methods Women undergoing benign gynecologic surgery were randomized to either “conventional” delayed urinary catheter care removal on postoperative day 1 or day of surgery catheter removal (fast track) 4 hours after surgery. Subjects were asked to complete a brief survey recording bladder function before and during their hospitalization and satisfaction with their catheter management. Subjects were contacted by phone 2 to 3 weeks after the index surgery to survey their bladder function including symptoms (eg, dysuria) or treatment indicative of a bladder infection. Results The median dwell time for Foley catheters in the “fast-track” group was 8.15 hours (SD = 375 minutes), whereas the median dwell time in the conventional group was 20.6 hours (SD = 265 minutes), which was significantly different (P < 0.001). Overall, 153 (93%) patients passed their voiding trial with significantly more patients passing their voiding trial in the conventional management group (P = 0.01). There was no difference in the Urogenital Distress Inventory scores at 2 weeks between catheter management cohorts (P = 0.81). Conclusions Foley dwell time is significantly reduced in the fast-track cohort. Voiding trial failure is higher with same-day catheter removal but that rate of failure rate is low. Patient satisfaction, the Urogenital Distress Inventory score, and postoperative urinary tract infection rates are not significantly different between cohorts.

Cateterización urinaria en cirugía general prolongada: una revisión de la literatura

“…En contexto de cirugía ambulatoria, el cateterismo intermitente es una alternativa razonable. En pacientes hospitalizados lo ideal es no sobrepasar las 24 h de SF [3], [11], [14], [15]. El uso de US puede ayudar a evaluar volúmenes sobre 600 ml y la necesidad de cateterismo.…”

Early and Standard Urinary Catheter Removal After Gynecological Surgery for Benign Lesions: A Quasi-Experimental Study

“…The timing of catheter removal is the most important risk factor for urinary tract infections (UTIs) (Brackmann et al, 2020; Kranz et al, 2020; Umscheid et al, 2011) and immediate or early removal of catheters can not only reduce the risk of UTIs, but also improve patient comfort (Ahmed et al, 2014; Ellahi et al, 2021; Nicolle, 2014). Studies have shown that when urinary output must be monitored, Foley catheters can remain in situ for at least 24 hours after surgery, with no increase in rates of problems with voiding such as urinary retention, or bladder atony, and without increased risks of catheter-related adverse events, including UTIs (Chai & Pun, 2011; Lang et al, 2020). The use of catheters can also cause irritation of the urethra and urinary bladder, with resultant pain, and interference with ambulation (Ahmed et al, 2014; Liang et al, 2009).…”