Do not catheterize the bladder at operative laparoscopy

Abstract

ObjectiveBladder catheterization at operative laparoscopy is currently routine, although this may be associated with an increased risk of urinary tract infection and urethral trauma. We wanted to establish whether non‐catheterization is practical or whether it results in problems with operative view or postoperative urinary retention.DesignProspective study with historical controls.SettingMinimal‐access surgery unit at a tertiary referral centre.Subjects40 consecutive women undergoing operative gynaecological laparoscopy.InterventionsPatients were only catheterized intraoperatively if bladder filling interfered with surgery, or postoperatively if they failed to pass urine within 6 h. The rate of urinary infection was compared with 40 historical controls who were routinely catheterized.ResultsThere were no cases of intraoperative bladder trauma. In total, five patients (12.5%) required a urinary catheter, three intraoperatively and two postoperatively. The likelihood of catheterization was significantly associated with an operating time >100 min (P < 0.01). One woman (2.5%), who was not catheterized had positive urine microbiology findings compared with five (12.5%) in the control group (P = 0.2). Although this was not statistically significant, this was not the main aim of our study. In fact, a total of 160 patients would be required to confirm a reduction in infection by 10%.ConclusionsBladder catheterization should not be routine prior to operative laparoscopy. Not only can most procedures be completed without catheterization, but it is likely that the risk of urinary infection would be reduced and there would be cost savings to the hospital.