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A systematic review and meta-analysis comparing immediate and delayed catheter removal following uncomplicated hysterectomy

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Abstract

Background

The use of an indwelling catheter after uncomplicated hysterectomy is common, but remains controversial because of the occurrence of catheter-associated urinary tract infections (UTIs) and discomfort.

Objective

To examine the evidence on the benefits and harm from the use of an indwelling catheter after uncomplicated hysterectomy.

Design

Systematic review and meta-analysis of randomized controlled trials (RCTs).

Data sources

Electronic databases including PubMed, Embase, the Cochrane Library, and Science Citation Index up to July 2014 were searched for relevant RCTs and the reference lists of the included studies were also searched manually.

Review methods

Included studies were RCTs comparing immediate and delayed catheter removal following uncomplicated hysterectomy without concomitant pelvic floor surgery. Two independent reviewers identified relevant RCTs, assessed their methodological quality and extracted data. Mantel-Haenszel estimates were calculated and pooled using a fixed or random effects model data are expressed as relative risks (RRs) and 95 % confidence intervals (CIs).

Results

Ten RCTs with a total of 1,188 patients that met the inclusion criteria were analysed. Early catheter removal was associated with a reduced risk of positive urine culture (RR 0.60, 95 % CI 0.40 to 0.88) and symptomatic UTI (RR 0.23, 95 % CI 0.10 to 0.52). However, the incidence of recatheterization was lower among patients with delayed catheter removal (RR 3.32, 95 % CI 1.48 to 7.46). There was no significant difference in febrile morbidity associated with UTI between the two approaches (RR 0.38, 95 % CI 0.11 to 1.36). In addition, delayed catheter removal was associated with a longer time to first ambulation (standard mean difference −2.73, 95 % CI −4.00 to −1.47].

Conclusions

The existing evidence from RCTs suggests that delayed catheter removal following uncomplicated hysterectomy increases the incidence of postoperative bacteriuria and symptomatic UTI but reduces the risk of recatheterization.

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Abbreviations

RCT:

randomized controlled trial.

RR:

relative risk.

SMD:

standard mean difference.

CI:

confidence intervals.

UTI:

urinary tract infection.

PRISMA:

the Preferred Reporting Items for Systematic Reviews and Meta-Analysis.

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Acknowledgements

We thank the anonymous reviewer for detailed and constructive comments that greatly improved the manuscript.

Conflict of Interest

None.

Author information

Authors and Affiliations

  1. Department of Urology, Zhongnan Hospital, Wuhan University, 115 Donghu load, Wuchang district, Wuhan, 430071, Hubei, China

    Peng Zhang, Wan-Li Hu, Long Cheng & Yang-Jun Zeng

  2. School of Basic Medicine, Department of Medicine, Wuhan University, Wuhan, Hubei, 430071, People’s Republic of China

    Bei Cheng

  3. Department of Endocrinology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, 430071, People’s Republic of China

    Xiao-Kan Xiong

Authors
  1. Peng Zhang
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  2. Wan-Li Hu
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Corresponding author

Correspondence to Wan-Li Hu.

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Appendix S1

Search strategy for parallel randomized controlled trials meeting inclusion criteria (DOCX 17 kb)

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Zhang, P., Hu, WL., Cheng, B. et al. A systematic review and meta-analysis comparing immediate and delayed catheter removal following uncomplicated hysterectomy. Int Urogynecol J 26, 665–674 (2015). https://doi.org/10.1007/s00192-014-2561-0

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  • DOI: https://doi.org/10.1007/s00192-014-2561-0

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