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Short term urinary catheter policies following urogenital surgery in adults

  • Review
  • Intervention

Authors


Abstract

Background

Urinary catheterisation (by the urethral or suprapubic routes) is common following urogenital surgery. There is no consensus on how to minimize complications and practice varies.

Objectives

To establish the optimal way to manage urinary catheters following urogenital surgery in adults.

Search methods

We searched the Cochrane Incontinence Group specialised trials register (searched 30 May 2005) and the reference lists of relevant articles.

Selection criteria

Randomised and quasi-randomised trials were identified. Studies were excluded if they were not randomised or quasi-randomised trials of adults being catheterised following urogenital surgery.

Data collection and analysis

Data collection was performed independently by two of the review authors and cross-checked. Where data might have been collected but not reported, clarification was sought from the trialists.

Main results

Thirty nine randomised trials were identified for inclusion in the review. They were generally small and of poor or moderate quality reporting data on only few outcomes. Confidence intervals were all wide.

Using a urinary catheter versus not using one
The data from five trials were heterogeneous but tended to indicate a higher risk of (re)catheterisation if a catheter was not used postoperatively. The data gave only an imprecise estimate of any difference in urinary tract infection.

Urethral catheterisation versus suprapubic catheterisation
In six trials, a greater number of people needed to be recatheterised if a urethral catheter rather than a suprapubic one was used following surgery (RR 3.66, 95% CI 1.41 to 9.49).

Shorter postoperative duration of catheter use versus longer duration
In 11 trials, the seven trials with data suggested fewer urinary tract infections when a catheter was removed earlier (for example 1 versus 3 days, RR 0.50, 95% CI 0.29 to 0.87) with no pattern in respect of catheterisation.

Clamp and release policies before catheter removal versus immediate catheter removal
In a single small trial, the clamp-and-release group showed a significantly greater incidence of urinary tract infections (RR 4.00, 95% 1.55 to 10.29) and a delay in return to normal voiding (RR 2.50, 95% CI 1.16 to 5.39).

Authors' conclusions

Despite reviewing 39 eligible trials, few firm conclusions could be reached because of the multiple comparisons considered, the small size of individual trials, and their low quality. Whether or not to use a particular policy is usually a trade-off between the risks of morbidity (especially infection) and risks of recatheterisation.

摘要

背景

在成人生殖泌尿手術後的短期導尿管使用探討

在生殖泌尿手術後,導尿管(經尿道或是經由恥骨上)是被建議需要施行的。然而對於如何減少併發症以及該如何實行並沒有一致的共識。

目標

是為了建立在成人生殖泌尿手術後導尿管使用的理想方式。

搜尋策略

我們搜尋了Cochrane資料庫中的失禁分類(在2005/05/30進行搜尋),包括了實驗性的以及在參考資料中的相關文章。

選擇標準

選擇文章的標準是隨機實驗以及半隨機實驗(Randomised and quasirandomised trial)。對於不是以在生殖泌尿手術後使用導尿管的成人為對象的這兩類型的實驗設計,都會被排除。

資料收集與分析

資料的收集以及互相校對是由兩位獨立的評論作者完成的。已經被收集的資料有可能沒被報導出來。

主要結論

有39個隨機實驗包括在這篇回顧文章裡。他們大多都是小規模以及有著不充分到中度品質的資料,以及只有少數的結果。信賴區間也都是寬的。對於是否要使用導尿管,雖然五個隨機實驗的報告並不完全一致,但都趨向於如果沒有在術後使用導尿管,會導致之後較高的必須(再)使用導尿管的風險。這些資料只給了我們在泌尿道感染差異上粗略的估計。在6個實驗中比較了經尿道以及經恥骨上導尿管置入,發現在數後有較高的比例是使用經尿道的導尿管(RR 3.66, 95% CI 1.41 to 9.49)。有11個實驗比較了使用導尿管的時間長短,其中7個實驗發現當導尿管是較易拔除的時候(沒有再去區分導尿管是經尿道或是恥骨上),也伴隨了較低的泌尿道感染機會(比較1以及3天,RR 0.50, 95% CI 0.29 to 0.87)。在其中一個小的實驗,比較了在拔除導尿管之前先將其用夾子夾著,然後再鬆開,以及直接將導尿管拔除這兩者間的泌尿道感染情形,發現有使用夾子再鬆開的方式有著顯著較高的泌尿道感染機會(RR 4.00, 95% 1.55 to 10.29)以及較高延遲正常排尿的比例(RR 2.50, 95% CI 1.16 to 5.39)。

作者結論

儘管回顧了39篇符合篩選標準的實驗,但其中只有少數有明確的結論,造成這樣的原因像是因為多面向的比較,小規模的研究,以及較低的品質造成的。然而不管是不是有特定執行的政策,考量的風險通常是在發病(特別是泌尿感染)以及再次的導尿管插入中交替著。

翻譯人

本摘要由中國醫藥大學附設醫院郭鐘元翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

在成人生殖泌尿手術後的短期導尿管使用。在泌尿或是婦產直腸手術後,導尿管經常被用於監測尿量,使病人排尿以排空膀胱,幫助組織的修復。倒尿有有經由尿道以及經恥骨上兩種途徑。導尿管也有不同的設計,材質以及照顧的方法,這些導尿管也都是可以移除的。這篇湖故文章評估了這些選項的證據強度。其中5個實驗建議在術後最好要使用導尿管,因為有少數的病人在第一次使用導尿管後需要再次使用。有6個實驗提出,對於使用經恥骨上導尿管的族群,有少數病人需要因為尿液滯留而再次接受導尿管置入。在11個實驗中,發現較短時間的導尿管使用,有著比長時間的導尿管使用,更低的泌尿道感染。儘管在這篇回顧文章包含了39篇的實驗,但大體上來說其證據是薄弱的,而且都是小規模的研究,這並不能提供足夠足夠的證據以達成肯定的結論。更多的大型實驗以及更多參與者必須要再進入這領域。

Plain language summary

Short term urinary catheter policies following urogenital surgery in adults

Urinary catheters are often used after urological or gynaecological surgery to check on urine output, to allow patients to pass urine, to allow washing out of the bladder and to help tissues heal. They can be inserted via the urethra (tube between the bladder and the outside) or suprapubically (through the abdomen). Different designs or materials may be used for the catheters, and different ways of managing the catheters and their removal are available. This review assesses the evidence for these options.

Five trials suggested that it might be better to use a catheter after surgery than not to use one as fewer people needed to be re-catheterised if a catheter was used at first. Information from six trials suggested that fewer people needed to be re-catheterised for urinary retention if a suprapubic catheter was used instead of a urethral one. People in up to 11 trials had fewer urinary tract infections if the catheters were removed sooner rather than later.

Although 39 trials were included in the review in total, the evidence in general was poor and came from small studies, which often did not provide enough information to draw firm conclusions. Much larger trials with many more participants must be conducted.

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