Study on Removal of Urethral Catheter Immediately versus after 12 Hours following Caesarean Section - A Prospective Randomized Controlled Trial

BACKGROUND The most common obstetric surgical procedure is Caesarean section and it is associated with urinary tract infection which is related to prolonged use of indwelling catheter post-operatively. It is also associated with late ambulation and its complications. A five-year audit from a large teaching hospital in Kolkata showed a caesarean section rate of 49.9 percent amongst all deliveries and another study in Madras showed Caesarean section rate of 50 percent. Caesarean section like any other surgical procedure is not without risks. METHODS A prospective randomized control trial was done at R.G. Kar Medical College with 436 patients, equally distributed in two arms. In one arm, catheter was removed after twelve hours (control) and in the other arm (study group), the catheter was removed immediately after Caesarean section. RESULTS In the present study, amongst the result parameters, significant bacteriuria [Group A- 3 (1.4%) and Group B- 50 patients (22.9%)]; dysuria [Group A- 5 (2.3%) patients and Group B- 47 (21.6%)]; urinary frequency and urgency [Group A- 2 (0.9%) and Group B- 44 (20.2%)] were statistically significant (p<0.00001). On the other hand, association of fever [Group A-5 (2.3 %) and Group B- 9 patients (4.1%)] and retention of urine after catheter removal [Group A- 4 (1.8 %) and Group B- 5 (2.3%)] did not show statistically significant difference between the two groups (p>0.00001). But, duration of hospital stay in days (Chi-square value-89.8014) and post-operative ambulation time in hours (Chi-square value-287.3246), both show statistically significant difference between the two groups. (p<0.00001). CONCLUSIONS Immediate removal of the catheter post-operatively is definitely associated with decreased incidence of urinary symptoms and problems related to late ambulation. It is hoped that the results of the study will be clinically useful, and it will be beneficial in formulating a strategy for removal of catheter after Caesarean section. However, to formulate a globally accepted protocol regarding time of catheter removal, studies with larger sample size and preferably multi-centric studies are necessary.