Comparative effectiveness of interventions for managing postoperative catheter-related bladder discomfort: a systematic review and network meta-analysis
- 52 Downloads
Although many drugs or interventions have been studied to manage catheter-related bladder discomfort (CRBD), their comparative effectiveness is unknown. We attempted to assess the comparative effectiveness of the strategies to manage CRBD in patients undergoing urologic surgery including amikacin, solifenacin, darifenacin, butylscopolamine, dexmedetomidine, gabapentin, glycopyrrolate, ketamine, oxybutynin, resiniferatoxin, tolterodine, tramadol, caudal block, dorsal penile nerve block, lidocaine–prilocaine cream.
We performed an arm-based network meta-analysis including 29 trials with 2841 participants. Goodness of model fit was evaluated by deviance information criteria (DIC). The incidence of CRBD at 0, 1, and 6 h after surgery and the incidence of moderate to severe CRBD at 0, 1, and 6 h after surgery were compared.
Random effect model was selected according to DIC. Most of the drugs significantly decreased the incidence of CRBD except amikacin, tramadol at 0 and 1 h after surgery. Dexmedetomidine, solifenacin, caudal block, dorsal penile nerve block, resiniferatoxin, and gabapentin 1200 mg p.o. significantly decreased the incidence of CRBD at 6 h after surgery (gabapentin 1200: Odds ratio [OR] 0.02; SUCRA 95.6). Dexmedetomidine and tolterodine significantly decreased the incidence of moderate to severe CRBD at 0, 1, and 6 h after surgery (tolterodine at 6 h: OR 0.05; SUCRA 73.7).
Gabapentin was ranked best regarding the overall incidence of CRBD, while tolterodine was ranked best in reducing the severity of CRBD. However, a firm conclusion cannot be made from our analysis due to small-study number and heterogeneity regarding study setting and outcome measurement.
KeywordsCatheter-related bladder discomfort Network Meta-analysis Gabapentin Tolterodine
This study was supported by SNUH Research Fund (no. 2320170030). Study sponsors had no role in study design; data collection, analysis, and interpretation of data; writing the paper; and the decision to submit the report for publication.
This study was supported by SNUH Research Fund (no. 2320170030).
Compliance with ethical standards
Conflict of interest
The authors declared that they have no conflicts of interests.
- 1.Agarwal A, Raza M, Singhal V, Dhiraaj S, Kapoor R, Srivastava A, Gupta D, Singh P, Pandey C, Singh U. The efficacy of tolterodine for prevention of catheter-related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study. Anesth Analg. 2005;101:1065–7.CrossRefGoogle Scholar
- 4.Chung J, Ha H, Kim D, Joo J, Kim S, Sohn D, Kim S, Seo H. Evaluation of the efficacy of solifenacin for preventing catheter-related bladder discomfort after transurethral resection of bladder tumors in patients with non-muscle invasive bladder cancer: a prospective, randomized, multicenter study. Clin Genitourin Cancer. 2017;15:157–62.CrossRefGoogle Scholar
- 5.Kim H, Lim S, Seo H, Park H. Effect of glycopyrrolate versus atropine coadministered with neostigmine for reversal of rocuronium on postoperative catheter-related bladder discomfort in patients undergoing transurethral resection of bladder tumor: a prospective randomized study. J Anesth. 2015;29:831–5.CrossRefGoogle Scholar
- 6.Yun YZ, Mei XJ, Rong Z, Ping DR, Lei L. Dexmedetomidine reduces catheter-related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study. P R Health Sci J. 2016;35:191–6.Google Scholar
- 7.Verma R, Agarwal A, Singh PK, Gupta D, Shamim R. Evaluation of efficacy of amikacin for attenuation of catheter-related bladder discomfort in patients undergoing percutaneous nephrolithotomy: a prospective, randomized, placebo-controlled, double-blind study. Anesth Essays Res. 2016;10:613–7.CrossRefGoogle Scholar
- 21.Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, Ioannidis JP, Straus S, Thorlund K, Jansen JP, Mulrow C, Catala-Lopez F, Gotzsche PC, Dickersin K, Boutron I, Altman DG, Moher D. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. 2015;162:777–84.CrossRefGoogle Scholar
- 29.Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions (version 5.1.0). The Cochrane collaboration. 2011. http://www.cochrane-handbook.org. Accessed Mar 2011.
- 31.Xiaoqiang L, Xuerong Z, Juan L, Mathew BS, Xiaorong Y, Qin W, Lili L, Yingying Z, Jun L. Efficacy of pudendal nerve block for alleviation of catheter-related bladder discomfort in male patients undergoing lower urinary tract surgeries: a randomized, controlled, double-blind trial. Medicine (Baltimore). 2017;96:e8932.CrossRefGoogle Scholar
- 35.Hegde SS. Muscarinic receptors in the bladder: from basic research to therapeutics. Br J Pharmacol. 2006;147(Suppl 2):80–7.Google Scholar
- 36.Srivastava V, Nigam R, Agrawal S, Kumar S, Rambhad S, Kanaskar J. Evaluation of the efficacy of solifenacin and darifenacin for prevention of catheter-related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study. Minerva Anestesiol. 2016;82:867–73.PubMedGoogle Scholar