A systematic review and meta-analysis comparing immediate and delayed catheter removal following uncomplicated hysterectomy.

BACKGROUND: The use of an indwelling catheter after uncomplicated hysterectomy is common, but remains controversial because of the occurrence of catheter-associated urinary tract infections (UTIs) and discomfort. OBJECTIVE: To examine the evidence on the benefits and harm from the use of an indwelling catheter after uncomplicated hysterectomy. DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCTs). DATA SOURCES: Electronic databases including PubMed, Embase, the Cochrane Library, and Science Citation Index up to July 2014 were searched for relevant RCTs and the reference lists of the included studies were also searched manually. REVIEW METHODS: Included studies were RCTs comparing immediate and delayed catheter removal following uncomplicated hysterectomy without concomitant pelvic floor surgery. Two independent reviewers identified relevant RCTs, assessed their methodological quality and extracted data. Mantel-Haenszel estimates were calculated and pooled using a fixed or random effects model data are expressed as relative risks (RRs) and 95% confidence intervals (CIs). RESULTS: Ten RCTs with a total of 1,188 patients that met the inclusion criteria were analysed. Early catheter removal was associated with a reduced risk of positive urine culture (RR 0.60, 95% CI 0.40 to 0.88) and symptomatic UTI (RR 0.23, 95% CI 0.10 to 0.52). However, the incidence of recatheterization was lower among patients with delayed catheter removal (RR 3.32, 95% CI 1.48 to 7.46). There was no significant difference in febrile morbidity associated with UTI between the two approaches (RR 0.38, 95% CI 0.11 to 1.36). In addition, delayed catheter removal was associated with a longer time to first ambulation (standard mean difference -2.73, 95% CI -4.00 to -1.47]. CONCLUSIONS: The existing evidence from RCTs suggests that delayed catheter removal following uncomplicated hysterectomy increases the incidence of postoperative bacteriuria and symptomatic UTI but reduces the risk of recatheterization.

α1-adrenergic receptor antagonists versus placebo for female lower urinary tract symptoms: A meta-analysis.

The aim of the present study was to evaluate the effectiveness of α1-adrenergic receptor antagonists (α1ARAs) versus placebo for female patients with lower urinary tract symptoms (LUTS). A meta-analysis of randomized controlled trials was conducted. The main outcome indices used to measure the effectiveness were the total International Prostate Symptom Score (I-PSS) and maximum urinary flow rate of female patients receiving treatment for LUTS. The I-PSS quality of life (QOL) and average urinary flow rate (AFR) were also observed and analyzed. Two randomized controlled trials with a total of 213 patients were included. Meta-analysis results were as follows: Following 4 weeks of treatment, patients taking α1ARAs presented a significant advantage over patients under placebo in terms of total I-PSS [standardized mean difference (SMD), -0.67; 95% confidence interval (CI), -0.94 to -0.39] but no difference was observed in maximum urinary flow rate (SMD, -0.05; 95% CI, -0.32 to 0.22) between the experimental and control groups. The I-PSS QOL post-treatment was lower in the α1ARA group compared with that in the placebo group (SMD, -0.86; 95% CI, -1.32 to -0.40) according to one study, and in the other study the improvement of AFR was not significant (SMD, 0.09; 95% CI, -0.25 to 0.43). It was concluded that α1ARAs are more effective than placebo in female patients with LUTS.