Is it necessary to catheterise the bladder routinely before gynaecological laparoscopic surgery?
BACKGROUND
Catheterisation of the bladder was routinely performed before gynaecological laparoscopy, but such an established practice is not evidence based and may lead to an increase in postoperative urinary symptoms and urinary tract infection.


OBJECTIVE
To compare routine urethral catheterisation and non-catheterisation before laparoscopic surgery with respect to bladder injury, postoperative urinary symptoms and urinary tract infection (UTI).


METHODS
This was a prospective, double blind randomised study. All women undergoing gynaecological laparoscopy, both elective and emergency, were invited to participate in the study. Cases involving bladder dissection, second trimester pregnancy and those who could not void preoperatively were excluded. Patients were randomly allocated to catheterise group and non-catheterise group. Requirement of catheterisation in the non-catheterise group, bladder injury, postoperative catheterisation, urinary symptoms and UTI were studied.


RESULTS
Two hundred and seventy-nine women were recruited of whom 262 were suitable for final analysis. Each group contained 131 cases. Patient characteristics and operative parameters were comparable in both groups. There was no bladder injury. Four percent of the women in the non-catheterise group needed catheterisation and catheterisation was significantly associated with surgery longer than 90 min (P < 0.001). Postoperative UTI was insignificantly reduced in the non-catheterised group. When postoperative urinary symptoms and urinary tract infections were studied as a composite outcome, they were statistically significantly reduced in the non-catheterise group (P = 0.017).


CONCLUSIONS
The policy of non-catheterisation before gynaecological laparoscopic surgery is safe and feasible. Although the reduction in UTI is insignificant, the overall postoperative urinary problems (urinary symptoms or UTI) are reduced significantly.
Tang
Kwok Keung
KK
Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, China. kk1tang@hotmail.com
Wong
Chung Kit
CK
Lo
Siu Fai Leslie
SF
Ng
Tai Keung
TK
D000328:Adult; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005831:Genital Diseases, Female / Q000601:surgery; D013509:Gynecologic Surgical Procedures / Q000592:standards* / Q000639:trends; D006801:Humans; D010535:Laparoscopy / Q000592:standards* / Q000639:trends; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D016896:Treatment Outcome; D019564:Unnecessary Procedures; D014546:Urinary Catheterization / Q000009:adverse effects / Q000379:methods*; D014552:Urinary Tract Infections / Q000517:prevention & control*