Once-daily irrigation of long-term urethral catheters with normal saline. Lack of benefit. [Urinary catheterization: transurethral or suprapubic approach?]. A prospective, randomized trial comparing continuous bladder drainage with catheterization at abdominal hysterectomy. Do catheter washouts extend patency time in long-term indwelling urethral catheters? A randomized controlled trial of acidic washout solution, normal saline washout, or standard care. Trial without catheter following acute retention of urine. Urinary drainage following radical hysterectomy for cervical carcinoma - a pilot comparison of urethral and suprapubic routes. Is an indwelling catheter necessary for bladder drainage after modified Burch colposuspension? Assessment of the use of bladder washouts/instillations in patients with long-term indwelling catheters. A comparison of suprapubic and transurethral drainage for postoperative urinary retention in general surgical patients.
Urinary incontinence is often managed with a long-term urethral catheter after other methods have failed. Such urethral catheterization is associated with polymicrobial bacteriuria, catheter obstruction, fever, bacteremia, urinary tract stones, and death. Periodic catheter irrigation is a common but untested management procedure intended to prevent catheter obstruction, fevers, and/or bacteremia. To evaluate this technique, we performed a randomized crossover trial comparing ten weeks of once-daily normal saline irrigation with ten weeks of no irrigation in 32 long-term catheterized women. The incidence of catheter obstructions and febrile episodes and the prevalence and species of bacteriuria were similar whether examined as completed crossover patients (N = 23) or as partially completed trials (N = 9). Once-daily irrigation with normal saline of long-term urethral catheters is a time-consuming and costly procedure that is unlikely to have an impact on the morbidity associated with such catheters. 75 patients, needing a bladder drainage for nonurological indications and having sterile urines were studied after randomization into two groups. In the first group, drained with an urethral catheter, urinary infection took place in 12 (= 30%) patients, while it was detected in 4 (= 11%) drained with a suprapubic catheter. In this latter group, patients felt more comfortable, had less pain; the duration of urinary drainage and hospital stay was shorter. To compare the infection rate and post-operative morbidity between in-dwelling urinary catheterization and 'in-out' catheterization at the time of routine total abdominal hysterectomy.
                The study comprised 100 patients who were blindly randomized to have either an indwelling Foley catheter or an 'in-out' catheterization at the time of surgery. Follow-up data on the retention of urine, urinary symptoms and infection were obtained.
                Of the 95 patients with complete data, 36% of those undergoing in-out catheterization had urinary retention after operation, requiring bladder emptying, compared with 4% of those receiving an indwelling catheter (P < 0.001). In addition, 29% of the catheterized group had urinary tract bacteriuria compared with 13% of the uncatheterized group (P < 0.025).
                This randomized controlled trial showed that in-out urinary catheterization at the time of routine abdominal hysterectomy was associated with a significantly higher incidence of post-operative urinary retention compared with in-dwelling catheterization, and may have implications for long-term bladder function. Blockage of long-term indwelling catheters with mineral deposit is an ongoing management issue, but evidence on optimal management is lacking. Our purpose was to examine whether catheter washouts prevent or reduce catheter blockage.
                A multisite randomized controlled trial.
                Adults with long-term indwelling catheters that required changing every 3 weeks or less, living in the community, and requiring supportive or continuing care were recruited. Participants were randomly assigned to 1 of 3 groups: control (usual care, no washout), saline washout, or commercially available acidic washout solution (Contisol Maelor Pharmaceuticals Ltd, Wrexham, UK).
                At baseline visit, the catheter was changed and participants were followed weekly for 8 weeks, with checks for catheter patency and urine pH. Participants randomized to saline or commercial solution had a weekly washout with the appropriate solution. Endpoints were 8 weeks (completion data), 3 or more catheter changes in the 8-week period, or symptomatic urinary tract infection (UTI) requiring antibiotics. The study hypothesis was that catheter life would be extended by 25% in the commercial solution group. It was not possible to blind participants or research nurses to washout versus no intervention, but participants in the saline and washout solution groups were blinded to solution type.
                One hundred twelve potential participants were screened; 73 were enrolled, randomized, and included in the final analysis. Of these, 53 completed the full 8 weeks of data collection; 16 terminated early because of 3 catheter changes or self-reported 'UTI'. Other reasons for termination were hematuria, latex sensitivity, deceased/severe illness, or personal choice. Analysis of variance was used to analyze mean differences on demographic variables and mean number of weeks in study. Kaplan-Meier survival curve analysis showed no statistical difference between the groups in time to first catheter change.
                At this time, the evidence is insufficient to state whether catheter washout with saline or Contisol is more effective than usual care with no washout in preventing blocking. No increased risk of UTI was associated with washout regimes. A total of 60 patients with acute urinary retention were studied to establish whether a trial without a catheter was justified and to identify subgroups of patients most likely to benefit from this practice. The patients were randomly allocated to 3 groups; the catheters were removed either immediately after the bladder was emptied, or 24 or 48 h later; 17 patients urinated satisfactorily after removal of the catheter. Re-establishment of micturition was not associated with the length of history or severity of symptoms of prostatism, with age or the presence of urinary tract infection. The mean retained volume of urine in patients with a satisfactory result was 786 ml and 1069 ml in the failures. Of the 34 patients with retained volumes of less than 900 ml, 15 were successful in re-establishing micturition compared with 2 of 26 of those with retained volumes greater than 900 ml. The time of catheter removal was not important. The 17 successful patients were reviewed 6 months later. None reported further urinary retention; 6 had required prostatectomy for severe symptoms, 6 had minor symptoms and 5 were symptomless. It was concluded that a trial without a catheter is worthwhile, since 11 of 60 patients had not required surgery, but it should be avoided in patients with a residual volume exceeding 900 ml. Twenty-four patients who underwent radical hysterectomy and pelvic node dissection for cervical carcinoma were randomized in a pilot study to compare continuous postoperative drainage by urethral and suprapubic catheters. There were no statistically significant differences in either the duration of continuous catheter drainage before the return of spontaneous voiding or the incidence of urinary tract infection in the two groups. Power calculations reveal that 628 patients require to be entered into each arm of a future study in order to be able to detect the former difference should it exist (alpha = 0.05, beta = 0.2, difference = 16% of one s.d.) and 41 in the latter (alpha = 0.05, beta = 0.2, 92.9% urethral group had UTI, 70% suprapubic group had UTI). We conclude that differences in these objective measures of catheter efficacy and morbidity between the groups, if they exist, are clinically irrelevant. On this basis we suggest that individual gynaecological oncologists should continue to use whichever method of catheter drainage best suits their clinical practice. Catheterization is considered to be a mandatory procedure for adequate bladder drainage following an anti-incontinence operation until the recovery of normal voiding function occurs. We conducted this prospective study to challenge this practice. A total of 86 patients with genuine stress incontinence who underwent a modified Burch coplosuspension were randomized into two groups based on the day of operation. The study group consisted of 42 patients who had the transurethral Foley catheter removed postoperatively the next morning (Group A). The control group was composed of 43 patients who had the transurethral indwelling catheter left in place until the fifth postoperative day (Group B). The percentages of immediate voiding difficulties in Groups A and B were 7.1% and 0%, respectively ( P>0.05). The postoperative urinary tract infection rates of Groups A and B were 16.6% and 23.3%, respectively ( P>0.05). The success rates of our patients were not compromised after our modified operative procedures (78.6% with dry results and 19.0% with improved symptoms in Group A vs. 74.4% with dry results and 20.9% with improved symptoms in Group B, P >0.05). Our results imply that it is not necessary that an indwelling catheter, for bladder drainage, be left in place until the fifth postoperative day to prevent immediate voiding difficulties. A randomised cross-over study of 3 bladder washout treatments--saline, Suby G and Solution R--was conducted on 25 elderly females with long-term catheters in order to examine crystal formation and catheter encrustation. With 2 exceptions, all patients produced crystals; only 14 completed the study. While a significant reduction in struvite crystals was found in the returned acidic washout fluid, there was no significant reduction of crystals in the neutral (saline) washout following any of the 3-week periods of treatment. Uric acid crystals appeared with Suby G and Solution R and these solutions were associated with higher red cell deposits in the urine. There was no significant difference in catheter encrustation between the various washouts. Percutaneous suprapubic bladder drainage, using an indwelling Silastic catheter, was compared with transurethral catheterization for the management of postoperative urinary retention in general surgical patients. In a prospective controlled trail, the overall incidence of postoperative retention was 7%. The urinary infection rate was 70% with transurethral catheterization and 8% with suprapubic drainage. Patients accepted suprapubic damage much more readily than transurethral cateterization and both medical and nursing personnel found the former method easier to manage effectively. Also, the patients' ability to pass urine spontaneously could be assessed without removing the catheter. However, minor mechanical complications were more common with suprapubic drainage. The cost of the two systems is comparable. We conclude that the routine use of suprapubic catheter drainage in the management of postoperative urinary retention significantly reduces the incidence of infection and is the preferred method of treating this common complication.
The updated search could not reveal any additional evidence. Very few trials have compared different types of catheter for long-term bladder drainage. All trials were small and showed methodological weaknesses. Therefore, the evidence was not sufficient as a reliable basis for practical conclusions. Further, better quality trials are needed to address the current lack of evidence in this clinically important area.