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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

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Abstract

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.

Methods

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.

Results

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.

Conclusions

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.

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Abbreviations

IC:

Intermittent catheterization

CC:

Continuous catheterization

UTI:

Urinary tract infection

RCT:

Randomized clinical trial

RR:

Risk ratio

CI:

Confidence interval

GRADE:

Grades of Recommendation, Assessment, Development and Evaluation

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Acknowledgements

The authors thank Jinhui Tian and all members of the 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, 730000, China

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

  2. Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China

    Meixuan Li, Xiaoqin Wang, Huijuan Li, Yangqin Xun & Kehu Yang

  3. Evidence Based Social Science Research Center, Lanzhou University, Lanzhou, 730000, China

    Meixuan Li, Xiaoqin Wang, Huijuan Li, Yangqin Xun & Kehu Yang

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

    Meixuan Li, Xiaoqin Wang, Huijuan Li, Yangqin Xun & Kehu Yang

  5. Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China

    Xin Xing

  6. Chinese Medicine Faculty of Hong Kong Baptist University, Hong Kong, 999077, China

    Liang Yao

  7. Institute of Clinical Research and Evidence Based Medicine, The Gansu Provincial Hospital, Lanzhou, 730000, China

    Peijing Yan & Kehu Yang

  8. Department of Endoscopic Surgery, Chinese PLA Hospital, Xi’an, 710054, China

    Xinmin Yang

Authors
  1. Meixuan Li
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  2. Xin Xing
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  3. Liang Yao
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  9. Peijing Yan
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  10. Xu Hui
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  11. Xinmin Yang
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Correspondence to Xinmin Yang or Kehu Yang.

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Meixuan Li, Xin Xing and Liang Yao are co-first authors

Appendices

Appendix 1 Search strategy

PubMed

#1 urinary catheters[Mesh].

#2 intermittent urethral catheter*[Mesh].

#3 urinary catheters[Title/Abstract].

#4 continuous catheter*[Title/Abstract].

#5 transurethral catheter*[Title/Abstract].

#6 transurethral tube[Title/Abstract].

#7 urinary catheter*[Title/Abstract].

#8 urinary tube[Title/Abstract].

#9 urethral catheter*[Title/Abstract].

#10 urethral tube[Title/Abstract].

#11 intermittent urethral catheter*[Title/Abstract].

#12 techniques catheter*[Title/Abstract].

#13 intermittent self catheter*[Title/Abstract].

#14 clean intermittent catheter*[Title/Abstract].

#15 clean intermittent self-catheter*[Title/Abstract].

#16 “in–out” catheter*[Title/Abstract].

#17 intermittent urethral catheter*[Title/Abstract].

#18 urethral self catheter*[Title/Abstract].

#19 clean intermittent catheter*[Title/Abstract].

#20 bladder drainage[Title/Abstract].

#21 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20.

#22 “labor, obstetric”[Mesh].

#23 labor[Title/Abstract].

#24 labour[Title/Abstract].

#25 childbirth[Title/Abstract].

#26 obstetric labor[Title/Abstract].

#27 #22 OR #23 OR #24 OR #25 OR #26 OR #27.

#28 #21 AND #27

EMBASE

#1 ‘urinary catheters’/exp.

#2 ‘intermittent urethral catheter*’[Mesh].

#3 ‘urinary catheters’: ti,ab,kw.

#4 ‘continuous catheter*’: ti,ab,kw.

#5 ‘transurethral catheter*’: ti,ab,kw.

#6 ‘transurethral tube’: ti,ab,kw.

#7 ‘urinary catheter*’: ti,ab,kw.

#8 ‘urinary tube’: ti,ab,kw.

#9 ‘urethral catheter*’: ti,ab,kw.

#10 ‘urethral tube’: ti,ab,kw.

#11 ‘intermittent urethral catheter*’: ti,ab,kw.

#12 ‘techniques catheter*’: ti,ab,kw.

#13 ‘intermittent self catheter*’: ti,ab,kw.

#14 ‘clean intermittent catheter*’: ti,ab,kw.

#15 ‘clean intermittent self-catheter*’: ti,ab,kw.

#16 ‘in–out catheter*’: ti,ab,kw.

#17 ‘intermittent urethral catheter*’: ti,ab,kw.

#18 ‘urethral self catheter*’: ti,ab,kw.

#19 ‘clean intermittent catheter*’: ti,ab,kw.

#20 ‘bladder drainage’: ti,ab,kw.

#21 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20.

#22 ‘labor, obstetric’/exp.

#23 ‘labor’: ti,ab,kw.

#24 ‘labour’: ti,ab,kw.

#25 ‘childbirth’: ti,ab,kw.

#26 ‘obstetric labor’: ti,ab,kw.

#27 #22 OR #23 OR #24 OR #25 OR #26 OR #27.

#28 #21 AND #27

Cochrane library

#1 “urinary catheters”[Mesh]).

#2 “intermittent urethral catheter*”[Mesh].

#3 urinary catheters: ti,ab,kw.

#4 continuous catheter*: ti,ab,kw.

#5 transurethral catheter*: ti,ab,kw.

#6 transurethral tube: ti,ab,kw.

#7 urinary catheter*: ti,ab,kw.

#8 urinary tube: ti,ab,kw.

#9 urethral catheter*: ti,ab,kw.

#10 urethral tube: ti,ab,kw.

#11 intermittent urethral catheter*: ti,ab,kw.

#12 techniques catheter*: ti,ab,kw.

#13 intermittent self catheter*: ti,ab,kw.

#14 clean intermittent catheter*: ti,ab,kw.

#15 clean intermittent self-catheter*: ti,ab,kw.

#16 “in–out” catheter*: ti,ab,kw.

#17 intermittent urethral catheter*: ti,ab,kw.

#18 urethral self catheter*: ti,ab,kw.

#19 clean intermittent catheter*: ti,ab,kw.

#20 bladder drainage: ti,ab,kw.

#21 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20.

#22 “labor, obstetric”[Mesh].

#23 labor: ti,ab,kw.

#24 labour: ti,ab,kw.

#25 childbirth: ti,ab,kw.

#26 obstetric labor: ti,ab,kw.

#27 #22 OR #23 OR #24 OR #25 OR #26 OR #27.

#28 #21 AND #27

Appendix 2

Table 4 Characteristics of excluded studies
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Li, M., Xing, X., Yao, L. et al. 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. Int Urogynecol J 30, 1419–1427 (2019). https://doi.org/10.1007/s00192-019-03904-1

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  • DOI: https://doi.org/10.1007/s00192-019-03904-1

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