A systematic review comparing early with late removal of indwelling urinary catheters after pelvic organ prolapse surgery

Background An indwelling catheter is routinely used after pelvic organ prolapse surgery to prevent urinary retention. However, the timing of catheter removal remains controversial. Objectives To investigate the optimal timing of catheter removal following prolapse surgery. Methods Electronic databases including the Cochrane Center Controlled Test Center, Embase, CINAHL, MEDLINE, PubMed, Web of Science and CNKI were searched up to January 2010. Randomized controlled trials (RCTs) comparing different timings of catheter removal after prolapse surgery were eligible. Results from RCTs comparing early versus late removal were pooled, and different durations of catheterization were divided into three sub-comparisons (<= 2 days versus > 2 days; <= 1 day versus 2 days; < 1 day versus 1 day). Primary outcomes were urinary tract infection (UTI) and re-catheterization. Secondary outcomes were the length of hospital stay and patient-reported outcomes. Results Seven RCTs with 964 women were involved in the analysis. Early catheter removal was associated with a reduced incidence of UTI (RR 0.46, 95% CI 0.24 to 0.9) but an increased risk of re-catheterization (RR 2.67, 95% CI 1.6 to 4.48). Significant differences in primary outcomes were found in the sub-comparison of <= 2 days versus > 2 days. Three of six trials found a significantly shorter length of hospital stay in the early removal group. The results for postoperative pain were mixed. Conclusion Among patients following pelvic organ prolapse surgery, early catheter removal is preferred. Moreover, the timing for removal is preferably within 2 days postoperatively.