Use of indwelling urinary catheter at cesarean delivery

Abstract

Objective: An indwelling urinary catheter is a routine part of most cesarean deliveries performed today. Indications for its use include improving exposure at the time of surgery as well as avoiding postoperative urinary retention. Indwelling catheters, however, are associated with maternal discomfort, infection, delayed ambulation, and moderate cost. We studied whether avoidance of the use of an indwelling catheter was associated with intraoperative difficulty or postoperative voiding dysfunction. Methods: Patients undergoing elective/repeat, urgent, or emergent cesarean deliveries were included in the study. All procedures were performed by the first two authors. All patients were encouraged to void within 30 minutes of the start of surgery. Patients undergoing urgent or emergent cesarean deliveries were encouraged to void but were not excluded if circumstances did not allow. All patients underwent low transverse cesarean deliveries with either spinal or general anesthesia. The deliveries were performed in the standard manner with dissection of the bladder off the lower uterine segment and a single-layer uterine closure. Surgical time, time to first void, and number of patients with urinary retention requiring either single in-out catheterization or placement of indwelling urinary catheter were recorded. Results: One hundred and eighteen patients underwent cesarean delivery during the study period. Sixty (51%) had primary cesarean sections and 58 (49%) had repeat sections. Spinal anesthesia was administered to 70.3% and general anesthesia to 29.6%. The average surgery time was 28.5 minutes, and in no case did bladder distention interfere with exposure of the lower uterine segment. There were no intraoperative bladder injuries. The average time to first void was 252.9 minutes (range, 124–599 minutes). Six patients (5%) required urinary catheter drainage. Of those, four had in-out catheterization in the operating room after the procedure and one patient required in-out catheterization at 523 minutes postoperatively and voided on her own 4 hours later. One patient had an indwelling catheter placed 152 minutes after surgery because of vaginal bleeding. This remained in place for 12 hours, and the patient voided 3 hours after removal. All patients ambulated to the bathroom for their first void. There were no cases of urinary tract infection. Conclusion: The use of an indwelling urinary catheter is an unnecessary part of cesarean delivery. The absence of the catheter had no effect on surgical exposure of the lower uterine segment. Urinary retention was rarely encountered postoperatively, and the patients ambulated within hours of the surgery. Patients undergoing cesarean delivery (elective/repeat, urgent, or emergent) can safely avoid the use of an indwelling urinary catheter.