Immediate versus delayed removal of urinary catheter after laparoscopic hysterectomy: a randomised controlled trial

• Published in: BJOG : an international journal of obstetrics and gynaecology 2019-05, Vol.126 (6), p.804-813
• Main Authors: Sandberg, EM, Twijnstra, ARH, Meir, CA, Kok, HS, Geloven, N, Gludovacz, K, Kolkman, W, Nagel, HTC, Haans, LCF, Kapiteijn, K, Jansen, FW
• Format: Article
• Language: English
• Subjects: Adult; Catheters; Device Removal - methods; Evidence-based medicine; Female; Gynaecological Surgery; Humans; Hysterectomy; Hysterectomy - adverse effects; Hysterectomy - methods; Laparoscopic hysterectomy; Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - methods; Middle Aged; Outcome Assessment, Health Care; Postoperative Care - adverse effects; Postoperative Care - instrumentation; Postoperative Care - methods; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Postoperative Complications - physiopathology; Postoperative Complications - therapy; Surgery; Time Factors; urinary catheter; Urinary Catheterization - methods; Urinary Catheters; urinary retention; Urinary Retention - diagnosis; Urinary Retention - etiology; Urinary Retention - physiopathology; Urinary Retention - therapy; Urinary tract; Urinary tract infections; Urination - physiology
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.15580

Objective To evaluate if immediate catheter removal (ICR) after laparoscopic hysterectomy is associated with similar retention outcomes compared with delayed removal (DCR). Study design Non‐inferiority randomised controlled trial. Population Women undergoing laparoscopic hysterectomy in six hospitals in the Netherlands. Methods Women were randomised to ICR or DCR (between 18 and 24 hours after surgery). Primary outcome The inability to void within 6 hours after catheter removal. Results 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). Conclusion 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. Tweetable The advantages of immediate catheter removal after laparoscopic hysterectomy seem to outweigh the risk of bladder retention. Tweetable The advantages of immediate catheter removal after laparoscopic hysterectomy seem to outweigh the risk of bladder retention.