Hoe lang moet transurethrale katheterisatie toegepast worden na vaginale prolapschirurgie?

Objective: To determine whether prolonged urinary bladder catheterisation after vaginal prolapse surgery is advantageous. Design: Randomised Controlled Trial. Setting: A large training hospital in the Netherlands. Population: Patients undergoing anterior colporraphy. Outcome measures: Need for recatheterisation, urinary tract infection, mean duration of catheterisation and hospital stay. Materials and Methods: One hundred patients were included. Patients were randomised in two groups. In one group (n=50) a transurethral catheter was in place for four days postoperatively and removed on the fifth postoperative day. In the other group (n=50) catheterisation was not prolonged and ceased the morning after surgery. Residual volumes after removal of the catheter were measured by ultrasound scanning. In case of residual volumes of >200 ml a second catheter was placed for 3 more days (recatheterisation). Urinary cultures were taken before removal of the katheter. Six patients were excluded, 4 in the standard prolonged catheterisation group and 2 in the not prolonged catheterisation group. Results: Residual volume exceeding 200 ml and therefore need for recatheterisation was observed in 9% in the group standard prolonged catheterisation versus 40% of patients in the not prolonged catheterisation group (OR 0.15, limits 0.045-0.47). Positive urine cultures were found in 40% of cases in the standard prolonged catheterisation group compared with 4% in the not prolonged catheterisation group (OR 15, limits 3.2-68.6). Mean duration of catheterisation was 5.3 days in the standard prolonged catheterisation group and 2.3 days in the not prolonged catheterisation group (p<0.001). Mean duration of hospitalisation was 7 days in the standard prolonged catheterisation group and 5.7 days in the not prolonged group (p<0.001). Conclusion The advantages of prolonged katheterisation do not outweight the disadvantages, therefore, katheterisation should not only be prolonged on indication.