Abstract
BackgroundTraditional practice after vaginal hysterectomy was to keep the vaginal pack and urinary catheter for 24 hours post operatively. But there were studies that prolonged cathterisation was associated with urinary infection. So this study was conducted to compare the post operative outcome when the urinary catheter and vaginal pack were removed after 3 hours and after 24 hours after surgery.MethodsThe study was done in the Department of Obstetrics and Gynecology, in a tertiary teaching institute of South India from September 2008 to March 2010. It was a randomised controlled trial involving 200 women undergoing vaginal surgery, who were randomly assigned to 2 groups – catheter and vaginal pack were removed either in 3 h in study group or were removed in 24 h in control group. The outcome of the study were vaginal bleeding, urinary retention, febrile morbidity, and urinary infection.ResultsThere was no significant difference between the study and control groups with respect to vaginal bleeding (0 and 1%, p = 1), urinary retention (9 and 4%, p = 0.15), febrile morbidity (7 and 4%, p = 0.35), and urinary infection (26% in each group, p = 1.0).ConclusionKeeping the urinary catheter and vaginal pack for 24 h following vaginal surgery does not offer any additional benefit against removing them after 3 h.
Highlights
Traditional practice after vaginal hysterectomy was to keep the vaginal pack and urinary catheter for 24 hours post operatively
The study group comprised of 100 patients in whom the bladder catheter and vaginal pack were removed in 3 h and the control group comprised of 100 women in whom they were removed in 24 h
Traditional practice of keeping the catheter and pack for prolonged duration post operatively has changed with time, as it became evident that prolonging the duration did not have any additional benefit
Summary
Traditional practice after vaginal hysterectomy was to keep the vaginal pack and urinary catheter for 24 hours post operatively. This study was conducted to compare the post operative outcome when the urinary catheter and vaginal pack were removed after 3 hours and after 24 hours after surgery. Like any other surgery, has its own complications, like hemorrhage, intra-operative injury to bladder, ureter and bowel, post-operative febrile morbidity, urinary retention and urinary tract infections [2, 3]. It has been a traditional practice to place a vaginal pack following vaginal surgery to prevent reactionary hemorrhage, which hinders normal urinary voiding. To facilitate urinary drainage post-operatively, bladder is catheterized, but this is accompanied by an increased risk of urinary infection, inconvenience for the patients, higher costs and prolonged hospital stay. The duration of catheter and vaginal pack has been reduced over the years but still there are no consensus on minimizing the complications [4]
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