Skip to main content

Advertisement

SpringerLink
Log in

The incidence of urinary tract infection of different routes of catheterization following gynecologic surgery: a systematic review and meta-analysis of randomized controlled trials

  • Review Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

We performed a systematic review of randomized controlled trials to assess the incidence of urinary tract infection (UTI) and complications of different urinary drainage methods (indwelling urinary catheterization, suprapubic catheterization, and intermittent catheterization.).

Methods

PubMed, EMBASE, and Cochrane Library were systematically searched from their inception to March 2018. We selected randomized controlled trials (RCTs) comparing at least two of the three possible urinary drainage routes after gynecologic surgery. A meta-analysis was performed using the RevMan software, and a random-effects model was used to pool the effect size. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to rate the quality of evidence.

Results

Fifteen RCTs met eligibility criteria (N = 1607), the meta-analysis indicated that suprapubic drainage was associated with a reduction in the rate of asymptomatic bacteriuria compared with indwelling urinary catheterization [risk ratios (RR) = 0.39, 95% confidence interval (CI): 0.24–0.65, P = 0.0003) but was associated with a higher rate of hematuria (RR = 4.49, 95% CI: 1.16–17.41, P = 0.03). Indwelling urinary catheterization increased the rate of recatheterization compared with suprapubic drainage (RR = 2.95, 95% CI: 1.22–7.11, P = 0.02) and was associated with higher rate of symptomatic UTI compared with intermittent catheterization (RR = 2.79, 95% CI: 1.09–7.14, P = 0.03). No difference was found in other aspects (complication rate and catheter-related pain) among the three drainage routes.

Conclusions

This meta-analysis suggested that suprapubic drainage was superior to indwelling urethral catheterization in reduction of asymptomatic bacteriuria and rate of recatheterization but was associated with higher rate of hematuria. Intermittent catheterization was associated with a reduction in symptomatic UTI compared with indwelling urinary catheterization. More high-quality randomized trials are needed to determine which route is most appropriate for catheterization in patients after gynecologic surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

RCT:

Randomized clinical trial

CI:

Confidence interval

RR:

Risk ratio

References

  1. Geller EJ. Prevention and management of postoperative urinary retention after urogynecologic surgery. Int J Womens Health. 2014;6:829–38. https://doi.org/10.2147/IJWH.S55383.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Buchko BL, Robinson LE. An evidence-based approach to decrease early post-operative urinary retention following urogynecologic surgery. Urol Nurs. 2012;32:260–4.

    Article  PubMed  Google Scholar 

  3. Partoll LM. Efficacy of tension-free vaginal tape with other pelvic reconstructive surgery. Am J Obstet Gynecol. 2002;186:1292–8.

    Article  PubMed  Google Scholar 

  4. Stanton SL, Ozsoy C, Hilton P. Voiding difficulties in the female: prevalence, clinical and urodynamic review. Obstet Gynecol. 1983;61:144–7.

    CAS  PubMed  Google Scholar 

  5. Kidd EA, Stewart F, Kassis NC et al. Urethral (indwelling or intermittent) or suprapubic routes for short-term catheterisation in hospitalised adults. Cochrane Database Syst Rev. 2015;(12):CD004203. https://doi.org/10.1002/14651858.

  6. Healy EF, Walsh CA, Cotter AM, et al. Suprapubic compared with transurethral bladder catheterization for gynecologic surgery: a systematic review and meta-analysis. Obstet Gynecol. 2012;120:678–87. https://doi.org/10.1097/AOG.

    Article  PubMed  Google Scholar 

  7. Stekkinger E, Linden PJQVD. A comparison of suprapubic and transurethral catheterization on postoperative urinary retention after vaginal prolapse repair: a randomized controlled trial. Gynecol Obstet Investig. 2011;72:109–16.

    Article  Google Scholar 

  8. Kringel U, Reimer T, Tomczak S, et al. Postoperative infections due to bladder catheters after anterior colporrhaphy: a prospective, randomized three-arm study. Int Urogynecol. 2010;21:1499–504. https://doi.org/10.1007/s00192-010-1221-2.

    Article  Google Scholar 

  9. Schiøtz HA, Malme PA, Tanbo TG. Urinary tract infections and asymptomatic bacteriuria after vaginal plastic surgery: a comparison of suprapubic and transurethral catheters. Acta Obstet Gynecol Scand. 1989;68:453–5.

    Article  PubMed  Google Scholar 

  10. Dixon L, Dolan LM, Brown K, et al. RCT of urethral versus suprapubic catheterization. Br J Nurs. 2010;19:S7–S13.

    Article  PubMed  Google Scholar 

  11. Bray R, Cartwright R, Digesu A, et al. A randomised controlled trial comparing immediate versus delayed catheter removal following vaginal prolapse surgery. Eur J Obstet Gynecol Reprod Biol. 2017;210:314–8. https://doi.org/10.1016/j.ejogrb.2017.01.015.

    Article  PubMed  Google Scholar 

  12. Naik R, Maughan K, Nordin A, et al. A prospective randomised controlled trial of intermittent self-catheterisation vs. supra-pubic catheterisation for post-operative bladder care following radical hysterectomy. Gynecol Oncol. 2005;99:437–42.

    Article  CAS  PubMed  Google Scholar 

  13. Jannelli ML, Wu JM, Plunkett LW, et al. A randomized controlled trial of clean intermittent self-catheterization versus suprapubic catheterization after urogynecologic surgery. Am J Obstet Gynecol. 2007;197:72.e1–4.

    Article  Google Scholar 

  14. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62:e1–34. https://doi.org/10.1016/j.jclinepi.2009.06.006.

    Article  PubMed  Google Scholar 

  15. Tian J, Zhang J, Ge L, et al. The methodological and reporting quality of systematic reviews from China and the USA are similar. J Clin Epidemiol. 2017;85:50–8. https://doi.org/10.1016/j.jclinepi.2016.

    Article  PubMed  Google Scholar 

  16. Xiuxia L, Ya Z, Yaolong C, et al. The reporting characteristics and methodological quality of Cochrane reviews about health policy research. Health Policy. 2014;119:503–10. https://doi.org/10.1016/j.healthpol.

    Article  Google Scholar 

  17. Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:889–93. https://doi.org/10.1136/bmj.d5928.

    Article  Google Scholar 

  18. Guyatt GH, Oxman AD, Schünemann HJ, et al. GRADE guidelines: a new series of articles in the journal of clinical epidemiology. J Clin Epidemiol. 2011;64:380–2. https://doi.org/10.1016/j.jclinepi.2010.09.011.

    Article  PubMed  Google Scholar 

  19. Higgins JE. Cochrane handbook for systematic reviews of interventions. Naunyn-Schmiedeberg's Arch Exp Pathol Pharmakol. 2011;5:S38.

    Google Scholar 

  20. Norris SL, Meerpohl JJ, Akl EA, et al. The skills and experience of GRADE methodologists can be assessed with a simple tool. J Clin Epidemiol. 2016;79:150–8. https://doi.org/10.1016/j.jclinepi.2016.07.001.

    Article  PubMed  Google Scholar 

  21. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan) [Computer program]. Version 5.3; 2014.

  22. Wells GA, Shea BJ, O'Connell D, et al. The Newcastle–Ottawa scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Appl Eng Agric. 2012;18:727–34.

    Google Scholar 

  23. Egger M, Smith GD, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. Bmj. 1997;315:629–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Barents JW, Dankert J, Ilic P, et al. The indwelling catheter in gynecology and the development of bacteriuria; a comparative study of patients with the transurethral and the suprapubic catheter. Ned Tijdschr Geneeskd. 1978;122:1321–7.

    CAS  PubMed  Google Scholar 

  25. Bergman A, Matthews L, Ballard CA, et al. Suprapubic versus transurethral bladder drainage after surgery for stress urinary incontinence. Zhonghua Fu Chan Ke Za Zhi. 1987;22:144–6.

    Google Scholar 

  26. Harms E, Christmann U, Klock FK. Suprapubic urinary diversion following gynecologic operations. Hinyokika Kiyo. 1985;31:665–9.

    Google Scholar 

  27. Nwabineli NJ, Walsh DJ, Davis JA. Urinary drainage following radical hysterectomy for cervical carcinoma - a pilot comparison of urethral and suprapubic routes. Int J Gynecol Cancer. 1993:208-210.

  28. Wiser WL, Morrison JC, Loveday GL, et al. Management of bladder drainage following vaginal plastic repairs. Obstet Gynecol. 1974;44:65–71.

    CAS  PubMed  Google Scholar 

  29. Andersen JT, Heisterberg L, Hebjørn S, et al. Suprapubic versus transurethral bladder drainage after Colposuspension/vaginal repair. Acta Obstet Gynecol Scand. 1985;64:139–43.

    Article  CAS  PubMed  Google Scholar 

  30. Dobbs SP, Jackson SR, Wilson AM, et al. A prospective, randomized trial comparing continuous bladder drainage with catheterization at abdominal hysterectomy. Br J Urol. 1997;80:554–6.

    Article  CAS  PubMed  Google Scholar 

  31. Hakvoort RA, Thijs SD, Bouwmeester FW, et al. Comparing clean intermittent catheterisation and transurethral indwelling catheterisation for incomplete voiding after vaginal prolapse surgery: a multicentre randomised trial. BJOG Int J Obstet Gynaecol. 2012;119:113–4.

    Article  Google Scholar 

  32. Schröder UC, Bokeloh F, O'Sullivan M, et al. Guidelines on urological infections. Biomicrofluidics. 2015;13:361.

    Google Scholar 

  33. Nasr A. State of the globe: catheterizations continue to cultivate urinary infections. J Global Infect Dis. 2010;2:81–2. https://doi.org/10.4103/0974-777X.62869.

    Article  Google Scholar 

  34. Elvy J, Colville A. Catheter associated urinary tract infection: what is it, what causes it and how can we prevent it? J Infect Prev. 2009;10:36–43.

    Article  Google Scholar 

  35. Platt R, Polk BF, Murdock B, et al. Mortality associated with nosocomial urinary-tract infection. N Engl J Med. 1982;307:637–42.

    Article  CAS  PubMed  Google Scholar 

  36. Averbuch D, Nir-Paz R, Tenenbaum A, et al. Factors associated with bacteremia in young infants with urinary tract infection. Pediatr Infect Dis J. 2014;33:571–5. https://doi.org/10.1097/INF.

    Article  PubMed  Google Scholar 

  37. Oh WS, Kim YS, Yeom JS, et al. Developing a model to estimate the probability of bacteremia in women with community-onset febrile urinary tract infection. J Infect Dev Ctries. 1972;10:1222–9. https://doi.org/10.3855/jidc.7559.

    Article  Google Scholar 

  38. Sylvester RJ, Canfield SE, Lam TB, et al. Conflict of evidence: resolving discrepancies when findings from randomized controlled trials and meta-analyses disagree. Eur Urol. 2017;72:e91–2. https://doi.org/10.1016/j.eururo.2017.04.007.

    Article  Google Scholar 

  39. Tenke P, Kovacs B, Johansen TEB et al European and Asian guidelines on management and prevention of catheter-associated urinary tract infections. Urologiia. 2008;(6):84-91.

Download references

Acknowledgments

The authors would like to thank Jinhui Tian, Wenru Shang, Lidong Hu, and all members of Evidence-Based Medicine Center, Lanzhou University, for their help with this study.

Author information

Authors and Affiliations

  1. School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, China

    Meixuan Li, Huijuan Li, Yangqin Xun, Meng Wang, Wenbo He & Kehu Yang

  2. Evidence Based Medicine Center, Lanzhou University, Lanzhou, 730000, People’s Republic of China

    Meixuan Li, Huijuan Li, Yangqin Xun, Cuncun Lu & Kehu Yang

  3. Evidence Based Social Science Research Center, Lanzhou, 730000, People’s Republic of China

    Meixuan Li, Huijuan Li, Yangqin Xun, Cuncun Lu & Kehu Yang

  4. Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People’s Republic of China

    Meixuan Li, Huijuan Li, Yangqin Xun, Cuncun Lu & Kehu Yang

  5. Chinese Medicine Faculty of Hong Kong Baptist University, Hong Kong, 999077, People’s Republic of China

    Liang Yao

  6. Institution of Clinical Research and Evidence Based Medicine, The Gansu Provincial Hospital, Lanzhou, 730000, People’s Republic of China

    Caiwen Han, Peijing Yan & Kehu Yang

  7. Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, People’s Republic of China

    Caiwen Han

  8. Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, People’s Republic of China

    Caiwen Han

Authors
  1. Meixuan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Liang Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Caiwen Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Huijuan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yangqin Xun
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peijing Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Meng Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Wenbo He
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Cuncun Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kehu Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kehu Yang.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Meixuan Li and Liang Yao are co-first author.

Appendix 1 search strategy

Appendix 1 search strategy

#1 Gynecologic Surgical Procedures[Mesh]

#2 Endometrial Ablation Techniques [Mesh]

#3 Hysterectomy[Mesh]

#4 Ovariectomy[Mesh]

#5 Salpingostomy[Mesh]

#6 Uterine Artery Embolization [Mesh]

#7 gynecologic surgery[Title/Abstract]

#8 pelvic organ prolapse repair[Title/Abstract])

#9 vaginal prolapse Repair[Title/Abstract])

#10 hysterectomy*[Title/Abstract]

#11 vaginal repair[Title/Abstract]

#12 urethral sling[Title/Abstract]

#13 colposuspension[Title/Abstract]

#14 colporrhaphy[Title/Abstract]

#15 vaginal plastic surgery[Title/Abstract]

#16 urogynecologic surgery[Title/Abstract]

#17 endometrial ablation technique*[Title/Abstract]

#18 ovariectom*[Title/Abstract]

#19 salpingostom*[Title/Abstract]

#20 uterine artery embolization[Title/Abstract]

#21 endometrioma*[Title/Abstract]

#22: #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21

#23 Urinary Catheters[Mesh])

#24 Intermittent Urethral Catheterization[Mesh]

#25 suprapubic catheter*[Title/Abstract]

#26 Suprapubic Tube[Title/Abstract]

#27 transurethral catheter*[Title/Abstract]

#28transurethral tube[Title/Abstract]

#29urinary catheter*[Title/Abstract]

#30 urinary tube[Title/Abstract]

#31 urethral catheter*[Title/Abstract]

#32 urethral tube[Title/Abstract]

#33 techniques catheterization[Title/Abstract]

#34 Intermittent Urethral Catheterization[Title/Abstract]

#35 intermittent self catheterization[Title/Abstract]

#36 clean intermittent catheterization[Title/Abstract]

#37 clean intermittent self-catheterization[Title/Abstract]

#38 in–out catheterization[Title/Abstract]

#39 intermittent urethral catheterizations[Title/Abstract]

#40 urethral self catheterization[Title/Abstract]

#41 clean intermittent catheterization[Title/Abstract]

#42 bladder drainage[Title/Abstract]

#43 #23 OR #24 OR #25 OR #26 OR #27 OR #28 OR #29 OR #30 OR #31 OR #32 OR #33 OR #34 OR #35 OR #36 OR #37 OR #38 OR #39 OR #40 OR #41 OR #42

#44 #22 AND #43

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, M., Yao, L., Han, C. et al. The incidence of urinary tract infection of different routes of catheterization following gynecologic surgery: a systematic review and meta-analysis of randomized controlled trials. Int Urogynecol J 30, 523–535 (2019). https://doi.org/10.1007/s00192-018-3791-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-018-3791-3

Keywords

Search

Navigation