International Urogynecology Journal

, Volume 30, Issue 9, pp 1419–1427 | Cite as

The effect of bladder catheterization on the incidence of urinary tract infection in laboring women with epidural analgesia: a meta-analysis of randomized controlled trials

  • Meixuan Li
  • Xin Xing
  • Liang Yao
  • Xiaoqin Wang
  • Wenbo He
  • Meng Wang
  • Huijuan Li
  • Yangqin Xun
  • Peijing Yan
  • Xu Hui
  • Xinmin YangEmail author
  • Kehu YangEmail author
Review Article


Introduction and hypothesis

There is conflicting evidence on whether intermittent catheterization (IC) is less associated with urinary tract infection (UTI) and more likely to prevent urinary retention than continuous catheterization (CC). We aimed to compare the effect of IC with that of CC on the incidence of postpartum UTI, urinary retention and hemorrhage in laboring women with epidural analgesia.


Electronic searches were performed in PubMed, EMBASE and Cochrane Library from their inception to October 2018. We selected RCTs comparing IC with CC in laboring women with epidural analgesia. 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.


Six RCTs (N = 850) were included in this review. The meta-analyses indicated that there was no significant difference between the IC and CC group in the incidence of postpartum UTI (RR = 1.25, 95% CI: 0.91 to 1.71, P = 0.16), postpartum urinary retention (RR = 0.76, 95% CI: 0.21 to 2.77, P = 0.68) and postpartum hemorrhage (RR = 1.72, 95% CI: 0.60 to 4.95, P = 0.31). GRADE assessment results showed that the quality of evidence was low.


Based on the available evidence, there is no measurable difference in rates of UTI between CC and IC, not that neither stragety decreases UTI, since the included trials do not address this.


Labor Epidural analgesia Urinary catheter Continuous catheterization Intermittent catheterization Bladder drainage 



Intermittent catheterization


Continuous catheterization


Urinary tract infection


Randomized clinical trial


Risk ratio


Confidence interval


Grades of Recommendation, Assessment, Development and Evaluation



The authors thank Jinhui Tian and all members of the Evidence-Based Medicine Center, Lanzhou University, for their help with this study.

Compliance with ethical standards

Conflicts of interest



  1. 1.
    Ullman R, Smith LA, Burns E, et al. Parenteral opioids for maternal pain relief in labour. Cochrane Database Syst Rev. 2010;65(9):CD007396.Google Scholar
  2. 2.
    Traynor AJ, Aragon M, Ghosh D, et al. Obstetric anesthesia workforce survey: a 30-year update. Anesth Analg. 2016;122(6):1939.CrossRefGoogle Scholar
  3. 3.
    Foon R, Toozs-Hobson P, Millns P, et al. The impact of anesthesia and mode of delivery on the urinary bladder in the postdelivery period. Int J Gynaecol Obstet. 2010;110(2):114–7.CrossRefGoogle Scholar
  4. 4.
    Musselwhite KL, Peter F, Katherine M, et al. Use of epidural anesthesia and the risk of acute postpartum urinary retention. Am J Obstet Gynecol. 2007;196(5):472 e1-72.e5.CrossRefGoogle Scholar
  5. 5.
    Liang CC, Chang SD, Tseng LH, et al. Postpartum urinary retention: assessment of contributing factors and long-term clinical impact. Aust N Z J Obstet Gynaecol. 2002;42(4):365–8.Google Scholar
  6. 6.
    Lewis JM, Yalla SV, Stanitski KE, et al. Spectrum of urodynamic abnormalities and renal function changes in adult men with non-neurogenic urinary retention. Neurourol Urodyn. 2012;31(4):544–8.CrossRefGoogle Scholar
  7. 7.
    Mustonen S, Ala-Houhala IO, Tammela TL. Long-term renal dysfunction in patients with acute urinary retention. Scand J Urol Nephrol. 2001;35(1):44–8.CrossRefGoogle Scholar
  8. 8.
    Care NCCFP. Postnatal Care: Routine Postnatal Care of Women and Their Babies [Internet]. 2006.Google Scholar
  9. 9.
    Wilson BL, Passante T, Rauschenbach D, et al. Bladder management with epidural anesthesia during labor: a randomized controlled trial. MCN Am J Matern Child Nurs. 2015;40(4):234–42; quiz E17-8. Scholar
  10. 10.
    Evron S, Dimitrochenko V, Khazin V, et al. The effect of intermittent versus continuous bladder catheterization on labor duration and postpartum urinary retention and infection: a randomized trial. J Clin Anesth. 2008;20(8):567–72. Scholar
  11. 11.
    Suleiman A, Mruwat-Rabah S, Garmi G, et al. Effect of intermittent versus continuous bladder catheterization on duration of the second stage of labor among nulliparous women with an epidural: a randomized controlled trial. Int Urogynecol J 2017;1–6
  12. 12.
    Alessandro L, Altman DG, Jennifer T, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Epidemiol Biostat Public Health. 2009;6(4):e1–e34.Google Scholar
  13. 13.
    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.Google Scholar
  14. 14.
    Liang Y, Rao S, Chen YL, et al. The quality of evidence in Chinese meta-analyses needs to be improved. J Clin Epidemiol. 2016;74:73–9.CrossRefGoogle Scholar
  15. 15.
    Lun L, Jinhui T, Hongliang T, et al. Network meta-analyses could be improved by searching more sources and by involving a librarian. J Clin Epidemiol. 2014;67(9):1001–7.CrossRefGoogle Scholar
  16. 16.
    Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ Br Med J. 2011;343(7829):889–93.Google Scholar
  17. 17.
    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(4):380–2.CrossRefGoogle Scholar
  18. 18.
    Green S. Cochrane handbook for systematic reviews of interventions: cochrane book series. Naunyn-Schmiedeberg's Arch Exp Pathol Pharmakol. 2011;5(2):S38.Google Scholar
  19. 19.
    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.CrossRefGoogle Scholar
  20. 20.
    Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan) [Computer program]. Version 5.3; 2014.Google Scholar
  21. 21.
    Vandenbroucke JP. Bias in meta-analysis detected by a simple, graphical test. Experts' views are still needed. BMJ Br Med J. 1997;316(7129):469–71.Google Scholar
  22. 22.
    Rivard C, Awad M, Liebermann M, et al. Bladder drainage during labor: a randomized controlled trial. J Obstet Gynaecol Res. 2012;38(8):1046–51. Scholar
  23. 23.
    Kerr-Wilson RHJ, McNally S. Bladder drainage for caesarean section under epidural analgesia. Br J Obstet Gynaecol. 1986;93(1):28–30.CrossRefGoogle Scholar
  24. 24.
    Millet L, Shaha S, Bartholomew ML. Rates of bacteriuria in laboring women with epidural analgesia: continuous vs intermittent bladder catheterization. Am J Obstet Gynecol. 2012;206(4):316.e1-7. Scholar
  25. 25.
    Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis. 2001;7(2):342–7.CrossRefGoogle Scholar
  26. 26.
    Stamm WE. Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. Am J Med. 1991;91(3):65S.CrossRefGoogle Scholar
  27. 27.
    Schröder UC, Bokeloh F, O'Sullivan M, et al. Guidelines on urological infections. Biomicrofluidics. 2015.Google Scholar
  28. 28.
    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(12):CD004203.Google Scholar

Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.School of Public HealthLanzhou UniversityLanzhouChina
  2. 2.Evidence Based Medicine Center, School of Basic Medical SciencesLanzhou UniversityLanzhouChina
  3. 3.Evidence Based Social Science Research CenterLanzhou UniversityLanzhouChina
  4. 4.Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu ProvinceLanzhouChina
  5. 5.Gansu University of Traditional Chinese MedicineLanzhouChina
  6. 6.Chinese Medicine Faculty of Hong Kong Baptist UniversityHong KongChina
  7. 7.Institute of Clinical Research and Evidence Based MedicineThe Gansu Provincial HospitalLanzhouChina
  8. 8.Department of Endoscopic SurgeryChinese PLA HospitalXi’anChina

Personalised recommendations