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- Title
Immediate versus delayed removal of urinary catheter after laparoscopic hysterectomy: a randomised controlled trial.
- Authors
Sandberg, EM; Twijnstra, ARH; Meir, CA; Kok, HS; Geloven, N; Gludovacz, K; Kolkman, W; Nagel, HTC; Haans, LCF; Kapiteijn, K; Jansen, FW; Sandberg, E M; van Meir, C A; Kok, H S; van Geloven, N; Jansen, F W
- Abstract
<bold>Objective: </bold>To evaluate if immediate catheter removal (ICR) after laparoscopic hysterectomy is associated with similar retention outcomes compared with delayed removal (DCR).<bold>Study Design: </bold>Non-inferiority randomised controlled trial.<bold>Population: </bold>Women undergoing laparoscopic hysterectomy in six hospitals in the Netherlands.<bold>Methods: </bold>Women were randomised to ICR or DCR (between 18 and 24 hours after surgery).<bold>Primary Outcome: </bold>The inability to void within 6 hours after catheter removal.<bold>Results: </bold>One hundred and fifty-five women were randomised to ICR (n = 74) and DCR (n = 81). The intention-to-treat and per-protocol analysis could not demonstrate the non-inferiority of ICR: ten women with ICR could not urinate spontaneously within 6 hours compared with none in the delayed group (risk difference 13.5%, 5.6-24.8, P = 0.88). However, seven of these women could void spontaneously within 9 hours without additional intervention. Regarding the secondary outcomes, eight women from the delayed group requested earlier catheter removal because of complaints (9.9%). Three women with ICR (4.1%) had a urinary tract infection postoperatively versus eight with DCR (9.9%, risk difference -5.8%, -15.1 to 3.5, P = 0.215). Women with ICR mobilised significantly earlier (5.7 hours, 0.8-23.3 versus 21.0 hours, 1.4-29.9; P ≤ 0.001).<bold>Conclusion: </bold>The non-inferiority of ICR could not be demonstrated in terms of urinary retention 6 hours after procedure. However, 70% of the women with voiding difficulties could void spontaneously within 9 hours after laparoscopic hysterectomy. It is therefore questionable if all observed urinary retention cases were clinically relevant. As a result, the clinical advantages of ICR may still outweigh the risk of bladder retention and it should therefore be considered after uncomplicated laparoscopic hysterectomy.<bold>Tweetable Abstract: </bold>The advantages of immediate catheter removal after laparoscopic hysterectomy seem to outweigh the risk of bladder retention.
- Subjects
URINARY catheters; HYSTERECTOMY; URINARY tract infections; RETENTION of urine; RISK retention; TREATMENT of surgical complications; COMPARATIVE studies; LAPAROSCOPY; RESEARCH methodology; MEDICAL cooperation; HEALTH outcome assessment; POSTOPERATIVE care; RESEARCH; SURGICAL complications; TIME; URINARY catheterization; URINATION; EVALUATION research; RANDOMIZED controlled trials; MEDICAL device removal; THERAPEUTICS
- Publication
BJOG: An International Journal of Obstetrics & Gynaecology, 2019, Vol 126, Issue 6, p804
- ISSN
1470-0328
- Publication type
journal article
- DOI
10.1111/1471-0528.15580