title: Strategies for the prevention of catheter-related bladder discomfort: A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  The ideal measures to prevent postoperative catheter-related bladder discomfort (CRBD) remain unestablished. We conducted the systematic review and meta-analysis to clarify the significance of potential interventions.
  
  
  METHODS
  We followed the Preferred Reporting Items for Systematic review and Meta-Analysis statement guidelines, and searched databases from MEDLINE, EMBASE, and referred Cochrane Library for randomized clinical trials (RCTs) published before December 2014. Reference lists from reviews or related articles were screened and checked for the related RCTs. Data extraction was performed carefully by 2 authors, respectively, and methodological quality was assessed by scoring system. Meta-analysis was applied for studies using the similar strategies or same reagents on the similar participants focused on CRBD. The primary outcome measure was the incidence of postoperative CRBD.
  
  
  RESULTS
  We identified 8 RCTs with interventions ranging from perioperative managements to pharmacological or multicomponent interventions. Meta-analysis showed ketamine was associated with less incidence of CRBD compared with placebo (pool risk ratio [RR] = -0.75, 95% confidence interval [CI] = 0.17-3.44, P < 0.01) at 0 hour, 1 hour (RR = -0.26, 95%CI = -0.38 to -0.13, P < 0.01), and 2 hours (RR = 0.31, 95%CI = 0.17-0.55, P < 0.01) and 6 hours (RR = 0.23, 95% CI = 0.11-0.49, P < 0.01) after operation. Oxybutynin did not affect the incidence of CRBD (RR = 0.46, 95%CI = 0.20-1.03, P = 0.06). Anticholinergic drugs also lower the incidence of CRBD at 0 hour (RR = 0.52, 95% CI = 0.38-0.71, P < 0.01), 1 hour (RR = 0.66, 95% CI = 0.51-0.86, P < 0.01), 2 hours (RR = 0.62, 95% CI = 0.46-0.84, P < 0.01), and 6 hours (RR = 0.56, 95%CI = 0.38-0.81, P < 0.01) postoperatively. Tramadol and gabapentin were also useful in lower the incidence and severity of CRBD in a RCT with 50 patients.
  
  
  CONCLUSIONS
  The included studies showed great effectiveness in incidence of postoperative CRBD. Meta-analysis supported that ketamine, oxybutynin, and anticholinergic reagents interventions were useful in preventing postoperative catheter-related bladder discomfort.
authors.affiliation: Department of Anesthesiology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Pudong, Shanghai Department of Medicine, Hebei North University, Zhangjiakou, Hebei Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai Ningxiang Hospital Affiliated to Hunan University of Chinese Medicine, Changsha, Hunan Department of Anesthesiology, Changzheng Hospital, the Second Military Medical University, Shanghai China.
authors.forename: Baoji
authors.initials: B
authors.lastname: Hu
authors.forename: Chengbao
authors.initials: C
authors.lastname: Li
authors.forename: Mengzhi
authors.initials: M
authors.lastname: Pan
authors.forename: Ming
authors.initials: M
authors.lastname: Zhong
authors.forename: Yu
authors.initials: Y
authors.lastname: Cao
authors.forename: Nannan
authors.initials: N
authors.lastname: Zhang
authors.forename: Hongbin
authors.initials: H
authors.lastname: Yuan
authors.forename: Hongwei
authors.initials: H
authors.lastname: Duan
mesh_terms: D006801:Humans; D016032:Randomized Controlled Trials as Topic; D001745:Urinary Bladder Diseases / Q000209:etiology* / Q000517:prevention & control*; D062885:Urinary Catheters / Q000009:adverse effects*