Bladder Care Following Benign Non-Hysterectomy Gynecological
Laparoscopy: A Randomized Clinical Trial
Abstract
Abstract Objective: To compare rates of urinary retention and
postoperative urinary tract infection between women with immediate
versus delayed removal of indwelling catheter following benign
non-hysterectomy gynecological laparoscopic surgery. Design: This
randomized clinical trial was conducted between February 2012 and
December 2019, with follow-up to six weeks, in two university-affiliated
hospitals in Sydney, Australia. Population: Study participants were 693
women over 18 years of age, undergoing non-hysterectomy laparoscopy for
benign gynecological conditions, excluding pelvic floor or concomitant
bowel surgery. Methods: 355 participants were randomized to immediate,
and 338 to delayed removal of urinary catheter. Main Outcome Measures:
The co-primary outcomes were urinary retention (assessed by trial of
void and need to re-catheterize) and urinary tract infection. Secondary
outcomes included readmission, analgesia requirements, duration of
hospitalization and validated bladder function questionnaires. Results:
Urinary retention for participants in the immediate removal group was
statistically higher at 8.2% (95% CI: 5.7% to 11.4%) vs. 4.2% (95%
CI: 2.7% to 7.2%) in the delayed removal group (p=.03). There was no
statistically significant difference in the rates of urinary tract
infection between the groups at 7.2% (95% CI:4.7% to 10.8%) in the
delayed group vs. 4.7% (95% CI: 2.8% to 7.8%) in the immediate
group. Conclusions: Rates of urinary retention and urinary tract
infection following non-hysterectomy benign gynecological laparoscopy
are low. There is a small increased risk of urinary retention with
immediate compared with delayed removal of urinary catheter. These
findings can be used to counsel patients regarding postoperative bladder
care.