Patients undergoing gynecological surgery commonly receive indwelling transurethral Foley catheters, however duration of catheterization is associated with risk of urinary tract infections and other adverse effects. Early removal of catheters is encouraged, however optimal timing postsurgery remains unclear. This quasi-experimental study compared outcomes for women after removal of a Foley catheter at two different times following benign gynecological surgery. Participants received either early catheter removal, within 6 hours of surgery (n = 38) or standard catheter removal, within 12 to 24 hours of surgery (n = 45). There were no significant differences in outcomes for discomfort scores or re-catheterization rates between groups. However, the early removal group had a significantly shorter time to first ambulation and shorter hospital stays. Early removal of Foley catheters in patients who underwent gynecological surgery did not increase adverse events. Early removal of catheters after gynecological surgery may decrease re-catheterization rates and increase patient satisfaction.
AhmedM. R.Sayed AhmedW. A.AtwaK. A.MetwallyL. (2014). Timing of urinary catheter removal after uncomplicated total abdominal hysterectomy: A prospective randomized trial. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 176, 60–63. https://doi.org/10.1016/j.ejogrb.2014.02.038
2.
BischS. P.JagoC. A.KalogeraE.GanshornH.MeyerL. A.RamirezP. T.DowdyS. C.NelsonG. (2021). Outcomes of enhanced recovery after surgery (ERAS) in gynecologic oncology - A systematic review and meta-analysis. Gynecologic Oncology, 161(1), 46–55.
3.
BrackmannM.CarballoE.UppalS.TorskiJ.ReynoldsR. K.McLeanK. (2020). Implementation of a standardized voiding management protocol to reduce unnecessary re-catheterization – a quality improvement project. Gynecologic Oncology, 157(2), 487–493. https://doi.org/10.1016/j.ygyno.2020.01.036
4.
CasteloM.Sue-Chue-LamC.KishibeT.AcunaS. A.BaxterN. N. (2020). Early urinary catheter removal after rectal surgery: systematic review and meta-analysis. BJS Open. 4(4), 545–553.
5.
ChaiJ.PunT. C. (2011). A prospective randomized trial to compare immediate and 24-hour delayed catheter removal following total abdominal hysterectomy. Acta Obstetricia et Gynecologica Scandinavica, 90(5), 478–482. https://doi.org/10.1111/j.1600-0412.2011.01104.x
6.
ChangC. P.HsuF. K.LaiM. J.ChangW. H.LeeN. R.LeeH. L.HorngH. C.WangP. H. (2019). Uterine-preserving pelvic organ prolapse surgery using the UPHOLD LITE vaginal support system: The outcomes of 291 patients. Medicine (Baltimore), 98(14), e15086. https://doi.org/10.1097/MD.0000000000015086
7.
ChangC. P.HsuF. K.LaiM. J.LeeH. L.HorngH. C.WangP. H. (2020). Voiding difficulty due to nearly complete labial fusion in a post-menopausal woman. Taiwanese Journal of Obstetrics Gynecology, 59(4), 621–622. doi: 10.1016/j.tjog.2020.05.030.
8.
ChangH. T.ChiuM. L.WangT. Y.ChenT. C.ChangC. L.SuT. H.WangK. G.WangK. L.YangY. C.ChenJ. R. (2020). Effect of chemotherapy, laparoscopy, and cytology on stage IC ovarian clear cell carcinoma: A long-term, single-center study. International Journal of Environmental Research and Public Health, 17(2), 491. https://doi.org/10.3390/ijerph17020491
9.
ChungK. C.LeeH. H.SuM. H.ChangW. H.LaiW. A.WangP. H. (2019). Ovarian fibrothecoma mimicking ovarian cancer: Using laparoscopy to avoid unnecessary exploratory laparotomy. Taiwanese Journal of Obstetrics and Gynecology, 58(6), 903–904. https://doi.org/10.1016/j.tjog.2019.09.026
10.
DemidenkoE. (2007). Sample size determination for logistic regression revisited. Statistics in Medicine, 26(18), 3385–3397. https://doi.org/10.1002/sim.2771
11.
Des JarlaisD. C.LylesC.CrepazN. (2004). Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: The TREND statement. American Journal of Public Health, 94(3), 361–366. https://doi.org/10.2105/ajph.94.3.361
12.
EllahiA.StewartF.KiddE. A.GriffithsR.FernandezR.OmarM. I. (2021). Strategies for the removal of short-term indwelling urethral catheters in adults. Cochrane Database of Systematic Reviews, 6(6), CD004011.
13.
GhezziF.CromiA.UccellaS.ColomboG.SalvatoreS.TomeraS.BolisP. (2007). Immediate foley removal after laparoscopic and vaginal hysterectomy: Determinants of postoperative urinary retention. Journal of Minimally Invasive Gynecology, 14(6), 706–711. https://doi.org/10.1016/j.jmig.2007.06.013
14.
HuangH.DongL.GuL. (2020). The timing of urinary catheter removal after gynecologic surgery a meta-analysis of randomized controlled trials. Medicine, 99(2), e18710. https://doi.org/10.1097/MD.0000000000018710
15.
JiangL. Y.WangP. H. (2019). Interstitial pregnancy: Cornuostomy or wedge resection?Journal of the Chinese Medical Association, 82(3), 167–168. https://doi.org/10.1097/JCMA.0000000000000072
16.
JoshiB.AggarwalN.ChopraS.TanejaN. (2014). A prospective randomized controlled comparison of immediate versus late removal of urinary catheter after abdominal hysterectomy. Journal of Mid-life Health, 5(2), 68–71. https://doi.org/10.4103/0976-7800.133990
17.
KalogeraE.NelsonG.LiuJ.HuQ. L.KoC. Y.WickE.DowdyS. C. (2018). Surgical technical evidence review for gynecologic surgery conducted for the Agency for Healthcare Research and Quality Safety Program for improving surgical care and recovery. American Journal of Obstetrics and Gynecology, 219(6), 563.e1–563.e19. https://doi.org/10.1016/j.ajog.2018.07.014
LangP.QuezadaY.WhitesideJ. (2020). Urinary catheter management approaches among women undergoing benign gynecologic surgery: A randomized trial. Female Pelvic Medicine & Reconstructive Surgery, 26(12), e73–e77. https://doi.org/10.1097/SPV.0000000000000781
20.
Letica-KriegelA. S.SalmasianH.VawdreyD. K.YoungermanB. E.GreenR. A.FuruyaE. Y.CalfeeD. P.PerotteR. (2019). Identifying the risk factors for catheter-associated urinary tract infections: A large cross-sectional study of six hospitals. BMJ Open, 9(2), e022137. https://doi.org/10.1136/bmjopen-2018-022137
21.
LiangC. C.LeeC. L.ChangT. C.ChangY. L.WangC. J.SoongY. K. (2009). Postoperative urinary outcomes in catheterized and non-catheterized patients undergoing laparoscopic-assisted vaginal hysterectomy–a randomized controlled trial. International Urogynecology Journal and Pelvic Floor Dysfunction, 20(3), 295–300. https://doi.org/10.1007/s00192-008-0769-6
22.
LiuC. H.LeeY. C.LinJ. C.ChanI. S.LeeN. R.ChangW. H.LiuW. M.WangP. H. (2019). Radical hysterectomy after neoadjuvant chemotherapy for locally bulky-size cervical cancer: A retrospective comparative analysis between the robotic and abdominal approaches. International Journal of Environmental Research and Public Health, 16(20), 3833. https://doi.org/10.3390/ijerph16203833
23.
NelsonG.AltmanA. D.NickA.MeyerL. A.RamirezP. T.AchtariC.AntrobusJ.HuangJ.ScottM.WijkL.AchesonN.LjungqvistO.DowdyS. C. (2016). Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced recovery after surgery (ERAS®) society recommendations—Part II. Gynecologic Oncology, 140(2), 323–332. https://doi.org/10.1016/j.ygyno.2015.12.019
24.
NelsonG.AltmanA. D.NickA.MeyerL. A.RamirezP. T.AchtariC.DowdyS. C. (2016b). Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations—Part I. Gynecologic Oncology, 140(2), 313–322. https://doi.org/10.1016/j.ygyno.2015.11.015
25.
NelsonG.Bakkum-GamezJ.KalogeraE.GlaserG.AltmanA.MeyerL. A.TaylorJ. S.IniestaM.LasalaJ.MenaG.ScottM.GillisC.EliasK.WijkL.HuangJ.NygrenJ.LjungqvistO.RamirezP. T.DowdyS. C. (2019). Guidelines for perioperative care in gynecologic/oncology: Enhanced recovery after surgery (ERAS) society recommendations—2019 update. International Journal of Gynecological Cancer, 29, 651–668. https://doi.org/10.1136/ijgc-2019-000356
26.
NicolleL. E. (2014). Catheter associated urinary tract infections. Antimicrobial Resistance and Infection Control, 3(1), 23. https://doi.org/10.1186/2047-2994-3-23
27.
OuladsahebmadarekE.Sayyah-MelliM.Jafari-ShobeiriM. (2012). A randomized clinical trial to compare immediate versus delayed removal of foley catheter following abdominal hysterectomy and laparotomy. Pakistan Journal of Medical Sciences, 28, 380–383.
28.
PolitD. F.BeckC. T. (2006). The content validity index: Are you sure you know what’s being reported? Critique and recommendations. Research in Nursing & Health, 29(5), 489–497. https://doi.org/10.1002/nur.20147 PMID: 16977646.
29.
PriceD. D.McGrathP. A.RafiiA.BuckinghamB. (1983). The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain, 17(1), 45–56. https://doi.org/10.1016/0304-3959(83)90126-4
30.
SandbergE.TwijnstraA.van MeirC.KokH.van GelovenN.GludovaczK.KolkmanW.NagelH.HaansL.KapiteijnK.JansenF. (2019). Immediate versus delayed removal of urinary catheter after laparoscopic hysterectomy: A randomised controlled trial. BJOG: An International Journal of Obstetrics and Gynaecology, 126(6), 804–813. https://doi.org/10.1111/1471-0528.15580
31.
SorieroD.AtzoriG.BarraF.PertileD.MassobrioA.ContiL.GusminiD.EpisL.GalloM.BanchiniF.CapelliP.PenzaV.ScabiniS. (2020). Development and validation of a homemade, low-cost laparoscopic simulator for resident surgeons (LABOT). International Journal of Environmental Research and Public Health, 17(1),323. https://doi.org/10.3390/ijerph17010323
32.
UmscheidC. A.MitchellM. D.DoshiJ. A.AgarwalR.WilliamsK.BrennanP. J. (2011). Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infection Control and Hospital Epidemiology, 32(2), 101–114. https://doi.org/10.1086/657912
33.
ZhangP.HuW. L.ChengB.ChengL.XiongX. K.ZengY. J. (2015). A systematic review and meta-analysis comparing immediate and delayed catheter removal following uncomplicated hysterectomy. International Urogynecology Journal, 26(5), 665–674. https://doi.org/10.1007/s00192-014-2561-0
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