Published evidence favors the use of suprapubic catheters in pelvic colorectal surgery

INTRODUCTION: Bladder catheterization is routine during pelvic colorectal surgery, and transurethral catheterization is the norm. However, in gynecologic surgery suprapubic catheters are commonly used and are reported to be superior to urethral catheters. METHODS: A review of published studies comparing urethral and suprapubic catheters in patients undergoing colorectal surgery is presented. Level one evidence from randomized, controlled trials is sparse. Five randomized, controlled trials, most with small numbers, have been published comparing urinary tract infection, urinary retention, duration of catheterization, pain and discomfort, and patient preference. RESULTS: Urinary tract infections were increased in the urethral group in three of the five articles. There were no differences between the two techniques with respect to urinary retention, but all studies commented on the ease with which this complication could be assessed and managed in the suprapubic group. There did not seem to be any difference in duration of catheterization. The suprapubic group experienced less pain and discomfort than the urethral group, and the suprapubic catheter was preferred by those patients who had experienced both. CONCLUSION: The results reported favor suprapubic over urethral catheterization in that urinary tract infections are reduced, particularly in females, and the ability to attempt normal voiding is facilitated, particularly in males.