Intraoperative Urinary Catheters Do Not Reduce Postoperative Urinary Retention Incidence: Presented at ACS

By Erin Burns, PhD

VIRTUAL -- October 27, 2021 -- Following elective laparoscopic inguinal hernia repair, the incidence of postoperative urinary retention is not reduced with the use of intraoperative urinary catheters, according to a study presented at the 2021 American College of Surgeons (ACS) Clinical Congress.

“To date, no randomised controlled trials have investigated the impact of urinary catheters on postoperative urinary retention following elective laparoscopic inguinal hernia repair,” said Katherine C. Montelione, MD, The Cleveland Clinic, Cleveland, Ohio.

The current multicentre, randomised trial randomised 490 adult patients undergoing elective laparoscopic unilateral or bilateral inguinal hernia repair to receive intraoperative urinary catheter placement (n = 240) or no urinary catheter placement (n = 250).

The primary outcome was postoperative urinary retention, defined as failure to void requiring straight urinary catheterisation or indwelling urinary catheter placement. Rates of urinary tract complications, including bladder injury, urethral trauma, and urinary tract infection, were investigated as exploratory outcomes.

Overall, 8.8% of patients were receiving diuretics, 17.3% were receiving pharmacotherapy for benign prostatic hyperplasia, and 81% received intraoperative anticholinergics.

Postoperative urinary retention occurred in 43 (8.87%) patients. No difference was observed in the rate of postoperative urinary retention between patients receiving intraoperative urinary catheter placement and those who did not receive intraoperative urinary catheter placement on univariate analysis (9.24% vs 8.50%; P = .899) and on multivariate logistic regression (odds ratio [OR] = 1.28; P = .475).

Multivariate regression revealed an association between postoperative urinary retention and increasing age (OR = 1.06; P = .001), the use of intraoperative anticholinergics (OR = 3.53; P = .045), and pre-existing benign prostatic hyperplasia (OR = 3.39; P

No patient experienced intraoperative bladder injury. There was 1 patient who experienced urethral trauma associated with catheter placement that ultimately required a suprapubic tube. A total of 8 patients developed urinary tract infections (0.85% with catheter vs 2.47% without; P = .285).

“Intraoperative urinary catheters are not superior to no catheter in preventing urinary retention following laparoscopic inguinal hernia repair,” said Dr. Montelione. “We no longer recommend routine placement of intraoperative urinary catheters during laparoscopic inguinal hernia repair if patients void preoperatively.”

[Presentation title: The Effect Of Intraoperative Urinary Catheter on Postoperative Urinary Retention After Laparoscopic Inguinal Hernia Repair: a Randomized Controlled Trial]

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