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


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


METHODS
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.


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.
Department of Urology, Zhongnan Hospital, Wuhan University, 115 Donghu load, Wuchang district, Wuhan, 430071, Hubei, China.
Peng
P
Zhang
Wan-Li
WL
Hu
Bei
B
Cheng
Long
L
Cheng
Xiao-Kan
XK
Xiong
Yang-Jun
YJ
Zeng
D002404:Catheterization; D002408:Catheters, Indwelling / Q000009:adverse effects; D020878:Device Removal; D004434:Early Ambulation; D005260:Female; D006801:Humans; D007044:Hysterectomy; D011182:Postoperative Care; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D062885:Urinary Catheters / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000209:etiology