Background:The prevalence of pelvic organ prolapse is very high in adult and elderly women, especially those who have delivered vaginally multiple times.Effective treatment strategies for these conditions are corrective vaginal surgeries.Routine transurethral catheterization after vaginal prolapse surgery is a standard practice to ensure a good surgical outcome, to reduce postoperative urinary retention (POUR), and for the convenience of care providers.However, the incidence of urinary tract infection (UTI) is linked with the duration of catheterization.Too early a removal of the catheter may result in a higher requirement for recatheterization.There is a lack of consensus regarding the optimal timing of removal of the urinary catheter.In this perspective, we planned our randomized controlled study on the removal of an indwelling transurethral catheter after 24 vs 72 hours following uncomplicated vaginal prolapse surgery.Materials and methods: In our RCT, randomization was computer generated with a 1:1 group allocation.Fifty patients were recruited in each group with matched baseline variables.The study was done at two tertiary centers situated in high prevalence of pelvic organ prolapse women population.Equal numbers of cases were recruited in both centers (25 each) in two groups at two study sites (i.e., 50 cases in each arm).Patients who were unable to void even 8 hours after removal of the catheter with a palpable bladder, or those showing a second-void residual urine volume of >150 mL, POUR was diagnosed and were recatheterized for the next 72 hours.Just before removal of the catheter, urine samples were collected for culture.The period of hospital stay was noted.Patient satisfaction was evaluated by the Patient Global Impression Scale of Improvement (PGI-I) scored (1-7) response.The primary outcome measure was the rate of POUR in the early vs conventional group.Secondary outcome measures were UTI/asymptomatic bacteriuria, time to ambulation, time to spontaneous voiding, hospital stay, and patient satisfaction.Results: The number of patients who required repeat catheterization (i.e., the rate of POUR) was higher in the early removal group.But the incidence of development of UTI and hospital stay was significantly lesser in the short-term catheterization group with a p-value of < 0.0001 and < 0.0002, respectively.No significant differences were noted in PGI-I in catheter removal after 24/72 hours (p-value = 0.6). Conclusion:Removal of an indwelling urinary catheter after 24 hours following uncomplicated vaginal prolapse surgery is significantly beneficial compared to removal after 72 hours to reduce the chances of urinary tract infection and hospital stay.
Agarwal et al. (Fri,) studied this question.