A systematic review comparing early with late removal of indwelling urinary catheters after pelvic organ prolapse surger
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REVIEW ARTICLE
A systematic review comparing early with late removal of indwelling urinary catheters after pelvic organ prolapse surgery Nansha Xie 1 & Zeyin Hu 2 & Zengjie Ye 3 & Qiong Xu 1 & Jie Chen 4 & Yan Lin 5 Received: 1 June 2020 / Accepted: 26 August 2020 # The International Urogynecological Association 2020
Abstract Background An indwelling catheter is routinely used after pelvic organ prolapse surgery to prevent urinary retention. However, the timing of catheter removal remains controversial. Objectives To investigate the optimal timing of catheter removal following prolapse surgery. Methods Electronic databases including the Cochrane Center Controlled Test Center, Embase, CINAHL, MEDLINE, PubMed, Web of Science and CNKI were searched up to January 2010. Randomized controlled trials (RCTs) comparing different timings of catheter removal after prolapse surgery were eligible. Results from RCTs comparing early versus late removal were pooled, and different durations of catheterization were divided into three sub-comparisons (≤ 2 days versus > 2 days; ≤ 1 day versus 2 days; < 1 day versus 1 day). Primary outcomes were urinary tract infection (UTI) and re-catheterization. Secondary outcomes were the length of hospital stay and patient-reported outcomes. Results Seven RCTs with 964 women were involved in the analysis. Early catheter removal was associated with a reduced incidence of UTI (RR 0.46, 95% CI 0.24 to 0.9) but an increased risk of re-catheterization (RR 2.67, 95% CI 1.6 to 4.48). Significant differences in primary outcomes were found in the sub-comparison of ≤ 2 days versus > 2 days. Three of six trials found a significantly shorter length of hospital stay in the early removal group. The results for postoperative pain were mixed. Conclusion Among patients following pelvic organ prolapse surgery, early catheter removal is preferred. Moreover, the timing for removal is preferably within 2 days postoperatively. Keywords Pelvic organ prolapse . Urinary tract infection . Urinary retention . Catheter
Introduction Pelvic organ prolapse is a common disease associated with pelvic floor dysfunction. For patients with severe prolapse,
Nansha Xie and Zeyin Hu contributed equally to this work. * Yan Lin [email protected] 1
Department of Urogynecology, Guangzhou Women and Children’s Medical Center, Guangzhou, China
2
Department of Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
3
Guangzhou University of Chinese Medicine, Guangzhou, China
4
Department of Pediatric Intensive Care Unit, Guangzhou Women and Children’s Medical Center, Guangzhou, China
5
Department of Nursing Administrative Office, Guangzhou Women and Children’s Medical Center, Guangzhou, China
surgery has been one of the vital treatments [1]. However, due to factors such as paraurethral edema and postoperative pain, this type of surgery is usually complicated with postoperative urinary retention, with the prevalence ranging from 5% to 42% [2–4]. As revealed by Geller [4] and Steggall et al. [5], urinary retention can have a
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