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


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.).


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.


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.


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.


Gynecologic surgery Urinary catheter Suprapubic catheterization Intermittent catheterization Bladder drainage 



Randomized clinical trial


Confidence interval


Risk ratio



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.


  1. 1.
    Geller EJ. Prevention and management of postoperative urinary retention after urogynecologic surgery. Int J Womens Health. 2014;6:829–38. Scholar
  2. 2.
    Buchko BL, Robinson LE. An evidence-based approach to decrease early post-operative urinary retention following urogynecologic surgery. Urol Nurs. 2012;32:260–4.CrossRefGoogle Scholar
  3. 3.
    Partoll LM. Efficacy of tension-free vaginal tape with other pelvic reconstructive surgery. Am J Obstet Gynecol. 2002;186:1292–8.CrossRefGoogle Scholar
  4. 4.
    Stanton SL, Ozsoy C, Hilton P. Voiding difficulties in the female: prevalence, clinical and urodynamic review. Obstet Gynecol. 1983;61:144–7.Google Scholar
  5. 5.
    Kidd EA, Stewart F, Kassis NC et al. Urethral (indwelling or intermittent) or suprapubic routes for short-term catheterisation in hospitalised adults. Cochrane Database Syst Rev. 2015;(12):CD004203.
  6. 6.
    Healy EF, Walsh CA, Cotter AM, et al. Suprapubic compared with transurethral bladder catheterization for gynecologic surgery: a systematic review and meta-analysis. Obstet Gynecol. 2012;120:678–87. Scholar
  7. 7.
    Stekkinger E, Linden PJQVD. A comparison of suprapubic and transurethral catheterization on postoperative urinary retention after vaginal prolapse repair: a randomized controlled trial. Gynecol Obstet Investig. 2011;72:109–16.CrossRefGoogle Scholar
  8. 8.
    Kringel U, Reimer T, Tomczak S, et al. Postoperative infections due to bladder catheters after anterior colporrhaphy: a prospective, randomized three-arm study. Int Urogynecol. 2010;21:1499–504. Scholar
  9. 9.
    Schiøtz HA, Malme PA, Tanbo TG. Urinary tract infections and asymptomatic bacteriuria after vaginal plastic surgery: a comparison of suprapubic and transurethral catheters. Acta Obstet Gynecol Scand. 1989;68:453–5.CrossRefGoogle Scholar
  10. 10.
    Dixon L, Dolan LM, Brown K, et al. RCT of urethral versus suprapubic catheterization. Br J Nurs. 2010;19:S7–S13.CrossRefGoogle Scholar
  11. 11.
    Bray R, Cartwright R, Digesu A, et al. A randomised controlled trial comparing immediate versus delayed catheter removal following vaginal prolapse surgery. Eur J Obstet Gynecol Reprod Biol. 2017;210:314–8. Scholar
  12. 12.
    Naik R, Maughan K, Nordin A, et al. A prospective randomised controlled trial of intermittent self-catheterisation vs. supra-pubic catheterisation for post-operative bladder care following radical hysterectomy. Gynecol Oncol. 2005;99:437–42.CrossRefGoogle Scholar
  13. 13.
    Jannelli ML, Wu JM, Plunkett LW, et al. A randomized controlled trial of clean intermittent self-catheterization versus suprapubic catheterization after urogynecologic surgery. Am J Obstet Gynecol. 2007;197:72.e1–4.CrossRefGoogle Scholar
  14. 14.
    Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62:e1–34. Scholar
  15. 15.
    Tian J, Zhang J, Ge L, et al. The methodological and reporting quality of systematic reviews from China and the USA are similar. J Clin Epidemiol. 2017;85:50–8. Scholar
  16. 16.
    Xiuxia L, Ya Z, Yaolong C, et al. The reporting characteristics and methodological quality of Cochrane reviews about health policy research. Health Policy. 2014;119:503–10. Scholar
  17. 17.
    Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:889–93. Scholar
  18. 18.
    Guyatt GH, Oxman AD, Schünemann HJ, et al. GRADE guidelines: a new series of articles in the journal of clinical epidemiology. J Clin Epidemiol. 2011;64:380–2. Scholar
  19. 19.
    Higgins JE. Cochrane handbook for systematic reviews of interventions. Naunyn-Schmiedeberg's Arch Exp Pathol Pharmakol. 2011;5:S38.Google Scholar
  20. 20.
    Norris SL, Meerpohl JJ, Akl EA, et al. The skills and experience of GRADE methodologists can be assessed with a simple tool. J Clin Epidemiol. 2016;79:150–8. Scholar
  21. 21.
    Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan) [Computer program]. Version 5.3; 2014.Google Scholar
  22. 22.
    Wells GA, Shea BJ, O'Connell D, et al. The Newcastle–Ottawa scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Appl Eng Agric. 2012;18:727–34.Google Scholar
  23. 23.
    Egger M, Smith GD, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. Bmj. 1997;315:629–34.CrossRefGoogle Scholar
  24. 24.
    Barents JW, Dankert J, Ilic P, et al. The indwelling catheter in gynecology and the development of bacteriuria; a comparative study of patients with the transurethral and the suprapubic catheter. Ned Tijdschr Geneeskd. 1978;122:1321–7.Google Scholar
  25. 25.
    Bergman A, Matthews L, Ballard CA, et al. Suprapubic versus transurethral bladder drainage after surgery for stress urinary incontinence. Zhonghua Fu Chan Ke Za Zhi. 1987;22:144–6.Google Scholar
  26. 26.
    Harms E, Christmann U, Klock FK. Suprapubic urinary diversion following gynecologic operations. Hinyokika Kiyo. 1985;31:665–9.Google Scholar
  27. 27.
    Nwabineli NJ, Walsh DJ, Davis JA. Urinary drainage following radical hysterectomy for cervical carcinoma - a pilot comparison of urethral and suprapubic routes. Int J Gynecol Cancer. 1993:208-210.Google Scholar
  28. 28.
    Wiser WL, Morrison JC, Loveday GL, et al. Management of bladder drainage following vaginal plastic repairs. Obstet Gynecol. 1974;44:65–71.Google Scholar
  29. 29.
    Andersen JT, Heisterberg L, Hebjørn S, et al. Suprapubic versus transurethral bladder drainage after Colposuspension/vaginal repair. Acta Obstet Gynecol Scand. 1985;64:139–43.CrossRefGoogle Scholar
  30. 30.
    Dobbs SP, Jackson SR, Wilson AM, et al. A prospective, randomized trial comparing continuous bladder drainage with catheterization at abdominal hysterectomy. Br J Urol. 1997;80:554–6.CrossRefGoogle Scholar
  31. 31.
    Hakvoort RA, Thijs SD, Bouwmeester FW, et al. Comparing clean intermittent catheterisation and transurethral indwelling catheterisation for incomplete voiding after vaginal prolapse surgery: a multicentre randomised trial. BJOG Int J Obstet Gynaecol. 2012;119:113–4.CrossRefGoogle Scholar
  32. 32.
    Schröder UC, Bokeloh F, O'Sullivan M, et al. Guidelines on urological infections. Biomicrofluidics. 2015;13:361.Google Scholar
  33. 33.
    Nasr A. State of the globe: catheterizations continue to cultivate urinary infections. J Global Infect Dis. 2010;2:81–2. Scholar
  34. 34.
    Elvy J, Colville A. Catheter associated urinary tract infection: what is it, what causes it and how can we prevent it? J Infect Prev. 2009;10:36–43.CrossRefGoogle Scholar
  35. 35.
    Platt R, Polk BF, Murdock B, et al. Mortality associated with nosocomial urinary-tract infection. N Engl J Med. 1982;307:637–42.CrossRefGoogle Scholar
  36. 36.
    Averbuch D, Nir-Paz R, Tenenbaum A, et al. Factors associated with bacteremia in young infants with urinary tract infection. Pediatr Infect Dis J. 2014;33:571–5. Scholar
  37. 37.
    Oh WS, Kim YS, Yeom JS, et al. Developing a model to estimate the probability of bacteremia in women with community-onset febrile urinary tract infection. J Infect Dev Ctries. 1972;10:1222–9. Scholar
  38. 38.
    Sylvester RJ, Canfield SE, Lam TB, et al. Conflict of evidence: resolving discrepancies when findings from randomized controlled trials and meta-analyses disagree. Eur Urol. 2017;72:e91–2. Scholar
  39. 39.
    Tenke P, Kovacs B, Johansen TEB et al European and Asian guidelines on management and prevention of catheter-associated urinary tract infections. Urologiia. 2008;(6):84-91.Google Scholar

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

Personalised recommendations