Question:
In a patient post elective vaginal surgery, what management of immediate post-op voiding problems gives the best long term result?
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Answer:
A systematic review of short term urinary catheter policies following urogenital surgery in adults (Phipps) found that “Due to the poor quality or small size of many of the trials, few conclusions can be reliably drawn. There was some weak evidence that there may be less need for recatheterisation if there is a short period of continuous drainage. For a range of gynaecological surgery, post-operative use of a suprapubic catheter reduced the incidence of recatheterisation, compared to use of a urethral catheter. Shorter duration of catheter use was associated with fewer urinary tract infections. One small trial suggested that there might be less bacteriuria if silver-coated catheters are used, but the effect on the incidence of symptomatic urinary tract infection or other morbidity was unknown, and this is consistent with another Cochrane review. The value of antibiotic instillation before catheter removal and of clamp-and release before catheter removal could not be assessed reliably.”
A review of strategies for the removal of short-term indwelling urethral catheters in adults. (Griffiths) found that “The evidence is consistent with midnight, rather than early morning, catheter removal leading to shorter hospital stays with consequent resource savings. Other evidence suggests that the timing of catheter removal is a balance between avoiding increased risk of infection (by early removal) and circumventing voiding dysfunction (by later removal). Early removal appears to reduce mean hospital stay, however. The evidence for assessing clamping indwelling urethral catheters prior to removal is limited, and there was no evidence regarding the use of alpha adrenergic blocker drugs. Until stronger evidence becomes available practices relating to clamping indwelling urethral catheters will continue to be dictated by local preferences and cost factors.”
This review including one study following vaginal surgery (Guzman)
(Evidence level 1a)
A review article on voiding dysfunction after anti-incontinence surgery was published in April 2009 (Natale)
References:
- Griffiths R, Fernandez R. Strategies for the removal of short-term indwelling urethral catheters in adults. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD004011. DOI: 10.1002/14651858.CD004011.pub3 Abstract (and free full text in some countries). Full text for Fellows, Members and Trainees
- Guzman S, Israel E, Puente R, Iglesias R, Rosa G, Ulloa C. Handling of Foley catheter regarding urinary retention syndrome following vaginal surgery. Revista Chilena de Obstetricia y Ginecologia 1994;59:280-3
- Natale F. La Penna C. Saltari M. Piccione E. Cervigni M. Voiding dysfunction after anti-incontinence surgery. [Review] [34 refs] Minerva Ginecologica. 61(2):167-72, 2009 Apr.
- Phipps S, Lim YN, McClinton S, Barry C, Rane A, N'Dow JMO. Short term urinary catheter policies following urogenital surgery in adults. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD004374. DOI: 10.1002/14651858.CD004374.pub2. Abstract (and free full text in some countries). Full text for Fellows, Members and Trainees
Search date: August 2010
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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