title: Implications of Foley catheterization in children with perforated appendicitis.
abstract: BACKGROUND
  We treat patients after appendectomy for perforated appendicitis with patient controlled analgesia (PCA) using a background continuous dose. We usually place urinary catheters in these patients because of concerns of urinary retention. The objective of the present study was to determine the rate of urinary retention in this patient population when a catheter was not used or was removed before the continuous PCA infusion was discontinued.
  
  
  METHODS
  We performed a retrospective review of all patients who had received PCA postoperatively for perforated appendicitis from December 2008 to May 2011. The demographics, need for replacement of a Foley catheter, number of recorded nursing calls to physicians, and the incidence of urinary tract infection was recorded. Patients who had received a urinary catheter intraoperatively were compared with those who had not. Subgroups were also created according to whether the patients with a Foley catheter had undergone removal of their catheter before or after cessation of the continuous PCA infusion.
  
  
  RESULTS
  Of 242 patients, 20 (8.3%) did not have a catheter postoperatively, 1 of whom required a catheter because of retention. Of the 222 patients who started with a catheter, 2 required reinsertion for retention (P = 0.59). Age, gender, and body mass index were similar for patients with and without a catheter. In the subgroup analysis, of the patients with a catheter, 48 (21.6%) had their catheter removed before discontinuation of the continuous PCA infusion and none required Foley catheter replacement. Of the 174 patients whose catheters were removed after discontinuation of the continuous PCA dose, 2 required catheter replacement (P = 0.46). A significantly higher percentage of telephone calls was generated for patients with a catheter than for patients without a Foley catheter (41.4% versus 10%, P = 0.007). No patients with a catheter developed a urinary tract infection.
  
  
  CONCLUSIONS
  Patients with a perforated appendicitis who receive a continuous PCA have a low rate of urinary retention whether or not a catheter has been placed intraoperatively.
authors.affiliation: Department of Pediatric Surgery, Children's Mercy Hospital and Clinics, Kansas City, Missouri 64108-4698, USA.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Thomas
authors.forename: E Marty
authors.initials: EM
authors.lastname: Knott
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Sharp
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
mesh_terms: D016058:Analgesia, Patient-Controlled / Q000009:adverse effects; D001062:Appendectomy; D001064:Appendicitis / Q000453:epidemiology / Q000601:surgery* / Q000628:therapy*; D002648:Child; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014546:Urinary Catheterization / Q000706:statistics & numerical data; D016055:Urinary Retention / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*
keywords: Appendicitis; Children; Foley catheter; Urinary retention