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

Abstract

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. To examine the evidence on the benefits and harm from the use of an indwelling catheter after uncomplicated hysterectomy. Systematic review and meta-analysis of randomized controlled trials (RCTs). 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. 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). 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]. 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.