title: A randomised controlled trial comparing immediate versus delayed catheter removal following vaginal prolapse surgery.
abstract: OBJECTIVE
  It is unclear if any catheterisation is necessary after vaginal surgery for pelvic organ prolapse. The aim of this study was to determine if indwelling catheterisation is necessary after these procedures.
  
  
  METHODS
  A randomised controlled trial of immediate post-operative removal of catheter compared to a suprapubic catheter (SPC) after vaginal prolapse surgery. In the Suprapubic group the catheter was left on free drainage until a voiding trial was commenced at 48h. Women in the immediate removal group underwent in/out catheterisation only if they had not voided by 8h after surgery to ensure the bladder did not over-distend.
  
  
  RESULTS
  55% (n=17) of patients in the immediate removal group did not require catheterisation postoperatively. A further 13 (42%) patients only required one in/out catheterisation 8h post operatively. In the immediate removal group duration of catheterisation was significantly shorter (median 0h, IQR 0-8h, range 0-16h) vs (6days (IQR 2-8days, range 2-19h) p=0.001). The duration of hospital stay (7days (range 3-16) vs. 9 (range 3-27) p=0.014), day of first mobilisation (Day 1, range 0-2, vs. Day 2, range 1-4, p=0.001), and rate of Symptomatic bacturia (16% vs. 52%, p<0.01) were all significantly better with immediate catheter removal.
  
  
  CONCLUSIONS
  After vaginal surgery for pelvic organ prolapse, the majority of patients do not require extended catheterisation. Early removal of a catheter reduces urinary tract infection and significantly decreases hospital stay. Such a policy should result in improved patient satisfaction and reduced hospital costs.
authors.affiliation: Department of Urogynaecology, St Marys Hospital, Imperial NHS Trust, Paddington, London W2 1NY, UK. Electronic address: rhiannon.bray1@nhs.net.
authors.forename: Rhiannon
authors.initials: R
authors.lastname: Bray
authors.affiliation: Department of Epidemiology and Biostatistics, Imperial College London, UK.
authors.forename: Rufus
authors.initials: R
authors.lastname: Cartwright
authors.affiliation: Department of Urogynaecology, St. Mary's Hospital, Imperial College NHS Trust, London, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Digesu
authors.affiliation: Department of Urogynaecology, St. Mary's Hospital, Imperial College NHS Trust, London, UK.
authors.forename: Ruwan
authors.initials: R
authors.lastname: Fernando
authors.affiliation: Department of Urogynaecology, St Mary's Hospital, Imperial NHS Trust, Paddington, London, UK.
authors.forename: Vik
authors.initials: V
authors.lastname: Khullar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D014546:Urinary Catheterization
keywords: Catheterisation; Intermittent; Prolapse surgery; Supra-pubic; UTI