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International Urogynecology Journal

, Volume 30, Issue 4, pp 523–535 | Cite as

The incidence of urinary tract infection of different routes of catheterization following gynecologic surgery: a systematic review and meta-analysis of randomized controlled trials

  • Meixuan Li
  • Liang Yao
  • Caiwen Han
  • Huijuan Li
  • Yangqin Xun
  • Peijing Yan
  • Meng Wang
  • Wenbo He
  • Cuncun Lu
  • Kehu YangEmail author
Review Article
  • 177 Downloads

Abstract

Introduction and hypothesis

We performed a systematic review of randomized controlled trials to assess the incidence of urinary tract infection (UTI) and complications of different urinary drainage methods (indwelling urinary catheterization, suprapubic catheterization, and intermittent catheterization.).

Methods

PubMed, EMBASE, and Cochrane Library were systematically searched from their inception to March 2018. We selected randomized controlled trials (RCTs) comparing at least two of the three possible urinary drainage routes after gynecologic surgery. A meta-analysis was performed using the RevMan software, and a random-effects model was used to pool the effect size. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to rate the quality of evidence.

Results

Fifteen RCTs met eligibility criteria (N = 1607), the meta-analysis indicated that suprapubic drainage was associated with a reduction in the rate of asymptomatic bacteriuria compared with indwelling urinary catheterization [risk ratios (RR) = 0.39, 95% confidence interval (CI): 0.24–0.65, P = 0.0003) but was associated with a higher rate of hematuria (RR = 4.49, 95% CI: 1.16–17.41, P = 0.03). Indwelling urinary catheterization increased the rate of recatheterization compared with suprapubic drainage (RR = 2.95, 95% CI: 1.22–7.11, P = 0.02) and was associated with higher rate of symptomatic UTI compared with intermittent catheterization (RR = 2.79, 95% CI: 1.09–7.14, P = 0.03). No difference was found in other aspects (complication rate and catheter-related pain) among the three drainage routes.

Conclusions

This meta-analysis suggested that suprapubic drainage was superior to indwelling urethral catheterization in reduction of asymptomatic bacteriuria and rate of recatheterization but was associated with higher rate of hematuria. Intermittent catheterization was associated with a reduction in symptomatic UTI compared with indwelling urinary catheterization. More high-quality randomized trials are needed to determine which route is most appropriate for catheterization in patients after gynecologic surgery.

Keywords

Gynecologic surgery Urinary catheter Suprapubic catheterization Intermittent catheterization Bladder drainage 

Abbreviations

RCT

Randomized clinical trial

CI

Confidence interval

RR

Risk ratio

Notes

Acknowledgments

The authors would like to thank Jinhui Tian, Wenru Shang, Lidong Hu, and all members of Evidence-Based Medicine Center, Lanzhou University, for their help with this study.

Compliance with ethical standards

Conflict of Interest

The authors declare that they have no conflict of interest.

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Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  • Meixuan Li
    • 1
    • 2
    • 3
    • 4
  • Liang Yao
    • 5
  • Caiwen Han
    • 6
    • 7
    • 8
  • Huijuan Li
    • 1
    • 2
    • 3
    • 4
  • Yangqin Xun
    • 1
    • 2
    • 3
    • 4
  • Peijing Yan
    • 6
  • Meng Wang
    • 1
  • Wenbo He
    • 1
  • Cuncun Lu
    • 2
    • 3
    • 4
  • Kehu Yang
    • 1
    • 2
    • 3
    • 4
    • 6
    Email author
  1. 1.School of Public HealthLanzhou UniversityLanzhouChina
  2. 2.Evidence Based Medicine CenterLanzhou UniversityLanzhouPeople’s Republic of China
  3. 3.Evidence Based Social Science Research CenterLanzhouPeople’s Republic of China
  4. 4.Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu ProvinceLanzhouPeople’s Republic of China
  5. 5.Chinese Medicine Faculty of Hong Kong Baptist UniversityHong KongPeople’s Republic of China
  6. 6.Institution of Clinical Research and Evidence Based MedicineThe Gansu Provincial HospitalLanzhouPeople’s Republic of China
  7. 7.Department of General SurgeryGansu Provincial HospitalLanzhouPeople’s Republic of China
  8. 8.Department of Clinical MedicineGansu University of Traditional Chinese MedicineLanzhouPeople’s Republic of China

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