The incidence of urinary tract infection of different routes of catheterization following gynecologic surgery: a systematic review and meta-analysis of randomized controlled trials
Introduction and hypothesis We performed a systematic review of randomized controlled trials to assess the incidence of urinary tract infection (UTI) and complications of different urinary drainage methods (indwelling urinary catheterization, suprapubic catheterization, and intermittent catheterizat...
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| Veröffentlicht in: | International Urogynecology Journal 2019-04, Vol.30 (4), p.523-535 |
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| creator | Li, Meixuan Yao, Liang Han, Caiwen Li, Huijuan Xun, Yangqin Yan, Peijing Wang, Meng He, Wenbo Lu, Cuncun Yang, Kehu |
| description | Introduction and hypothesis
We performed a systematic review of randomized controlled trials to assess the incidence of urinary tract infection (UTI) and complications of different urinary drainage methods (indwelling urinary catheterization, suprapubic catheterization, and intermittent catheterization.).
Methods
PubMed, EMBASE, and Cochrane Library were systematically searched from their inception to March 2018. We selected randomized controlled trials (RCTs) comparing at least two of the three possible urinary drainage routes after gynecologic surgery. A meta-analysis was performed using the RevMan software, and a random-effects model was used to pool the effect size. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to rate the quality of evidence.
Results
Fifteen RCTs met eligibility criteria (
N
= 1607), the meta-analysis indicated that suprapubic drainage was associated with a reduction in the rate of asymptomatic bacteriuria compared with indwelling urinary catheterization [risk ratios (RR) = 0.39, 95% confidence interval (CI): 0.24–0.65,
P
= 0.0003) but was associated with a higher rate of hematuria (RR = 4.49, 95% CI: 1.16–17.41,
P
= 0.03). Indwelling urinary catheterization increased the rate of recatheterization compared with suprapubic drainage (RR = 2.95, 95% CI: 1.22–7.11,
P
= 0.02) and was associated with higher rate of symptomatic UTI compared with intermittent catheterization (RR = 2.79, 95% CI: 1.09–7.14,
P
= 0.03). No difference was found in other aspects (complication rate and catheter-related pain) among the three drainage routes.
Conclusions
This meta-analysis suggested that suprapubic drainage was superior to indwelling urethral catheterization in reduction of asymptomatic bacteriuria and rate of recatheterization but was associated with higher rate of hematuria. Intermittent catheterization was associated with a reduction in symptomatic UTI compared with indwelling urinary catheterization. More high-quality randomized trials are needed to determine which route is most appropriate for catheterization in patients after gynecologic surgery. |
| doi_str_mv | 10.1007/s00192-018-3791-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2127201433</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2126732653</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-377f0f58b3bdaa0f0441aa386ce4c776cf58212d54ff726ad99e4382bda4658a3</originalsourceid><addsrcrecordid>eNp1kc1u1DAUhS0EokPLA7BBltiwCVz_JE7YoarQSpXYtOvI41xPXSV2sR2q9Ll4wDozBaRKrK7l891j-RxC3jH4xADU5wTAOl4BayuhOlaJF2TDpBCVAC5ekg10QlVCNvyIvEnpFgAk1PCaHAkQStZCbsjvqxukzhs3oDdIg6VzdF7HheaoTS6SRZNd8Ks0OGsxos80hjljWu-MzjeYMboHvcdsGMdw7_yO7haPJoxh5wxNc9xhXL5QTdOSMk4FNjTiL4f3VPuBTph1pb0el-T2vrHchsk94EBN8DkW23LM0ekxnZBXtgx8-zSPyfW3s6vT8-ryx_eL06-XlRGK55KJsmDrdiu2g9ZgQUqmtWgbg9Io1ZiiccaHWlqreKOHrkMpWl5o2dStFsfk48H3LoafM6bcTy4ZHEftMcypL8uKw5p4QT88Q2_DHMt_9lSjBG_qlWIHysSQUkTb30U3lbR7Bv1aaX-otC-V9mul_brz_sl53k44_N3402EB-AFIRfIl5n9P_9_1EeB2sKk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2126732653</pqid></control><display><type>article</type><title>The incidence of urinary tract infection of different routes of catheterization following gynecologic surgery: a systematic review and meta-analysis of randomized controlled trials</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Li, Meixuan ; Yao, Liang ; Han, Caiwen ; Li, Huijuan ; Xun, Yangqin ; Yan, Peijing ; Wang, Meng ; He, Wenbo ; Lu, Cuncun ; Yang, Kehu</creator><creatorcontrib>Li, Meixuan ; Yao, Liang ; Han, Caiwen ; Li, Huijuan ; Xun, Yangqin ; Yan, Peijing ; Wang, Meng ; He, Wenbo ; Lu, Cuncun ; Yang, Kehu</creatorcontrib><description>Introduction and hypothesis
We performed a systematic review of randomized controlled trials to assess the incidence of urinary tract infection (UTI) and complications of different urinary drainage methods (indwelling urinary catheterization, suprapubic catheterization, and intermittent catheterization.).
Methods
PubMed, EMBASE, and Cochrane Library were systematically searched from their inception to March 2018. We selected randomized controlled trials (RCTs) comparing at least two of the three possible urinary drainage routes after gynecologic surgery. A meta-analysis was performed using the RevMan software, and a random-effects model was used to pool the effect size. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to rate the quality of evidence.
Results
Fifteen RCTs met eligibility criteria (
N
= 1607), the meta-analysis indicated that suprapubic drainage was associated with a reduction in the rate of asymptomatic bacteriuria compared with indwelling urinary catheterization [risk ratios (RR) = 0.39, 95% confidence interval (CI): 0.24–0.65,
P
= 0.0003) but was associated with a higher rate of hematuria (RR = 4.49, 95% CI: 1.16–17.41,
P
= 0.03). Indwelling urinary catheterization increased the rate of recatheterization compared with suprapubic drainage (RR = 2.95, 95% CI: 1.22–7.11,
P
= 0.02) and was associated with higher rate of symptomatic UTI compared with intermittent catheterization (RR = 2.79, 95% CI: 1.09–7.14,
P
= 0.03). No difference was found in other aspects (complication rate and catheter-related pain) among the three drainage routes.
Conclusions
This meta-analysis suggested that suprapubic drainage was superior to indwelling urethral catheterization in reduction of asymptomatic bacteriuria and rate of recatheterization but was associated with higher rate of hematuria. Intermittent catheterization was associated with a reduction in symptomatic UTI compared with indwelling urinary catheterization. More high-quality randomized trials are needed to determine which route is most appropriate for catheterization in patients after gynecologic surgery.</description><identifier>ISSN: 0937-3462</identifier><identifier>EISSN: 1433-3023</identifier><identifier>DOI: 10.1007/s00192-018-3791-3</identifier><identifier>PMID: 30374534</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Bacteriuria - epidemiology ; Bacteriuria - etiology ; Catheters ; Catheters, Indwelling - adverse effects ; Clinical trials ; Cystostomy ; Female ; Gynecologic Surgical Procedures ; Gynecology ; Humans ; Incidence ; Intermittent Urethral Catheterization - adverse effects ; Intubation ; Length of Stay ; Medicine ; Medicine & Public Health ; Meta-analysis ; Pain - etiology ; Randomized Controlled Trials as Topic ; Review Article ; Surgery ; Systematic review ; Urinary Catheterization - adverse effects ; Urinary Catheterization - methods ; Urinary tract diseases ; Urinary tract infections ; Urogenital system ; Urology</subject><ispartof>International Urogynecology Journal, 2019-04, Vol.30 (4), p.523-535</ispartof><rights>The International Urogynecological Association 2018</rights><rights>International Urogynecology Journal is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-377f0f58b3bdaa0f0441aa386ce4c776cf58212d54ff726ad99e4382bda4658a3</citedby><cites>FETCH-LOGICAL-c372t-377f0f58b3bdaa0f0441aa386ce4c776cf58212d54ff726ad99e4382bda4658a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00192-018-3791-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00192-018-3791-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30374534$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Li, Meixuan</creatorcontrib><creatorcontrib>Yao, Liang</creatorcontrib><creatorcontrib>Han, Caiwen</creatorcontrib><creatorcontrib>Li, Huijuan</creatorcontrib><creatorcontrib>Xun, Yangqin</creatorcontrib><creatorcontrib>Yan, Peijing</creatorcontrib><creatorcontrib>Wang, Meng</creatorcontrib><creatorcontrib>He, Wenbo</creatorcontrib><creatorcontrib>Lu, Cuncun</creatorcontrib><creatorcontrib>Yang, Kehu</creatorcontrib><title>The incidence of urinary tract infection of different routes of catheterization following gynecologic surgery: a systematic review and meta-analysis of randomized controlled trials</title><title>International Urogynecology Journal</title><addtitle>Int Urogynecol J</addtitle><addtitle>Int Urogynecol J</addtitle><description>Introduction and hypothesis
We performed a systematic review of randomized controlled trials to assess the incidence of urinary tract infection (UTI) and complications of different urinary drainage methods (indwelling urinary catheterization, suprapubic catheterization, and intermittent catheterization.).
Methods
PubMed, EMBASE, and Cochrane Library were systematically searched from their inception to March 2018. We selected randomized controlled trials (RCTs) comparing at least two of the three possible urinary drainage routes after gynecologic surgery. A meta-analysis was performed using the RevMan software, and a random-effects model was used to pool the effect size. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to rate the quality of evidence.
Results
Fifteen RCTs met eligibility criteria (
N
= 1607), the meta-analysis indicated that suprapubic drainage was associated with a reduction in the rate of asymptomatic bacteriuria compared with indwelling urinary catheterization [risk ratios (RR) = 0.39, 95% confidence interval (CI): 0.24–0.65,
P
= 0.0003) but was associated with a higher rate of hematuria (RR = 4.49, 95% CI: 1.16–17.41,
P
= 0.03). Indwelling urinary catheterization increased the rate of recatheterization compared with suprapubic drainage (RR = 2.95, 95% CI: 1.22–7.11,
P
= 0.02) and was associated with higher rate of symptomatic UTI compared with intermittent catheterization (RR = 2.79, 95% CI: 1.09–7.14,
P
= 0.03). No difference was found in other aspects (complication rate and catheter-related pain) among the three drainage routes.
Conclusions
This meta-analysis suggested that suprapubic drainage was superior to indwelling urethral catheterization in reduction of asymptomatic bacteriuria and rate of recatheterization but was associated with higher rate of hematuria. Intermittent catheterization was associated with a reduction in symptomatic UTI compared with indwelling urinary catheterization. More high-quality randomized trials are needed to determine which route is most appropriate for catheterization in patients after gynecologic surgery.</description><subject>Bacteriuria - epidemiology</subject><subject>Bacteriuria - etiology</subject><subject>Catheters</subject><subject>Catheters, Indwelling - adverse effects</subject><subject>Clinical trials</subject><subject>Cystostomy</subject><subject>Female</subject><subject>Gynecologic Surgical Procedures</subject><subject>Gynecology</subject><subject>Humans</subject><subject>Incidence</subject><subject>Intermittent Urethral Catheterization - adverse effects</subject><subject>Intubation</subject><subject>Length of Stay</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Pain - etiology</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Review Article</subject><subject>Surgery</subject><subject>Systematic review</subject><subject>Urinary Catheterization - adverse effects</subject><subject>Urinary Catheterization - methods</subject><subject>Urinary tract diseases</subject><subject>Urinary tract infections</subject><subject>Urogenital system</subject><subject>Urology</subject><issn>0937-3462</issn><issn>1433-3023</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kc1u1DAUhS0EokPLA7BBltiwCVz_JE7YoarQSpXYtOvI41xPXSV2sR2q9Ll4wDozBaRKrK7l891j-RxC3jH4xADU5wTAOl4BayuhOlaJF2TDpBCVAC5ekg10QlVCNvyIvEnpFgAk1PCaHAkQStZCbsjvqxukzhs3oDdIg6VzdF7HheaoTS6SRZNd8Ks0OGsxos80hjljWu-MzjeYMboHvcdsGMdw7_yO7haPJoxh5wxNc9xhXL5QTdOSMk4FNjTiL4f3VPuBTph1pb0el-T2vrHchsk94EBN8DkW23LM0ekxnZBXtgx8-zSPyfW3s6vT8-ryx_eL06-XlRGK55KJsmDrdiu2g9ZgQUqmtWgbg9Io1ZiiccaHWlqreKOHrkMpWl5o2dStFsfk48H3LoafM6bcTy4ZHEftMcypL8uKw5p4QT88Q2_DHMt_9lSjBG_qlWIHysSQUkTb30U3lbR7Bv1aaX-otC-V9mul_brz_sl53k44_N3402EB-AFIRfIl5n9P_9_1EeB2sKk</recordid><startdate>20190401</startdate><enddate>20190401</enddate><creator>Li, Meixuan</creator><creator>Yao, Liang</creator><creator>Han, Caiwen</creator><creator>Li, Huijuan</creator><creator>Xun, Yangqin</creator><creator>Yan, Peijing</creator><creator>Wang, Meng</creator><creator>He, Wenbo</creator><creator>Lu, Cuncun</creator><creator>Yang, Kehu</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20190401</creationdate><title>The incidence of urinary tract infection of different routes of catheterization following gynecologic surgery: a systematic review and meta-analysis of randomized controlled trials</title><author>Li, Meixuan ; Yao, Liang ; Han, Caiwen ; Li, Huijuan ; Xun, Yangqin ; Yan, Peijing ; Wang, Meng ; He, Wenbo ; Lu, Cuncun ; Yang, Kehu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-377f0f58b3bdaa0f0441aa386ce4c776cf58212d54ff726ad99e4382bda4658a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Bacteriuria - epidemiology</topic><topic>Bacteriuria - etiology</topic><topic>Catheters</topic><topic>Catheters, Indwelling - adverse effects</topic><topic>Clinical trials</topic><topic>Cystostomy</topic><topic>Female</topic><topic>Gynecologic Surgical Procedures</topic><topic>Gynecology</topic><topic>Humans</topic><topic>Incidence</topic><topic>Intermittent Urethral Catheterization - adverse effects</topic><topic>Intubation</topic><topic>Length of Stay</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Pain - etiology</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Review Article</topic><topic>Surgery</topic><topic>Systematic review</topic><topic>Urinary Catheterization - adverse effects</topic><topic>Urinary Catheterization - methods</topic><topic>Urinary tract diseases</topic><topic>Urinary tract infections</topic><topic>Urogenital system</topic><topic>Urology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Li, Meixuan</creatorcontrib><creatorcontrib>Yao, Liang</creatorcontrib><creatorcontrib>Han, Caiwen</creatorcontrib><creatorcontrib>Li, Huijuan</creatorcontrib><creatorcontrib>Xun, Yangqin</creatorcontrib><creatorcontrib>Yan, Peijing</creatorcontrib><creatorcontrib>Wang, Meng</creatorcontrib><creatorcontrib>He, Wenbo</creatorcontrib><creatorcontrib>Lu, Cuncun</creatorcontrib><creatorcontrib>Yang, Kehu</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>International Urogynecology Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Li, Meixuan</au><au>Yao, Liang</au><au>Han, Caiwen</au><au>Li, Huijuan</au><au>Xun, Yangqin</au><au>Yan, Peijing</au><au>Wang, Meng</au><au>He, Wenbo</au><au>Lu, Cuncun</au><au>Yang, Kehu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The incidence of urinary tract infection of different routes of catheterization following gynecologic surgery: a systematic review and meta-analysis of randomized controlled trials</atitle><jtitle>International Urogynecology Journal</jtitle><stitle>Int Urogynecol J</stitle><addtitle>Int Urogynecol J</addtitle><date>2019-04-01</date><risdate>2019</risdate><volume>30</volume><issue>4</issue><spage>523</spage><epage>535</epage><pages>523-535</pages><issn>0937-3462</issn><eissn>1433-3023</eissn><abstract>Introduction and hypothesis
We performed a systematic review of randomized controlled trials to assess the incidence of urinary tract infection (UTI) and complications of different urinary drainage methods (indwelling urinary catheterization, suprapubic catheterization, and intermittent catheterization.).
Methods
PubMed, EMBASE, and Cochrane Library were systematically searched from their inception to March 2018. We selected randomized controlled trials (RCTs) comparing at least two of the three possible urinary drainage routes after gynecologic surgery. A meta-analysis was performed using the RevMan software, and a random-effects model was used to pool the effect size. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to rate the quality of evidence.
Results
Fifteen RCTs met eligibility criteria (
N
= 1607), the meta-analysis indicated that suprapubic drainage was associated with a reduction in the rate of asymptomatic bacteriuria compared with indwelling urinary catheterization [risk ratios (RR) = 0.39, 95% confidence interval (CI): 0.24–0.65,
P
= 0.0003) but was associated with a higher rate of hematuria (RR = 4.49, 95% CI: 1.16–17.41,
P
= 0.03). Indwelling urinary catheterization increased the rate of recatheterization compared with suprapubic drainage (RR = 2.95, 95% CI: 1.22–7.11,
P
= 0.02) and was associated with higher rate of symptomatic UTI compared with intermittent catheterization (RR = 2.79, 95% CI: 1.09–7.14,
P
= 0.03). No difference was found in other aspects (complication rate and catheter-related pain) among the three drainage routes.
Conclusions
This meta-analysis suggested that suprapubic drainage was superior to indwelling urethral catheterization in reduction of asymptomatic bacteriuria and rate of recatheterization but was associated with higher rate of hematuria. Intermittent catheterization was associated with a reduction in symptomatic UTI compared with indwelling urinary catheterization. More high-quality randomized trials are needed to determine which route is most appropriate for catheterization in patients after gynecologic surgery.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>30374534</pmid><doi>10.1007/s00192-018-3791-3</doi><tpages>13</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | International Urogynecology Journal, 2019-04, Vol.30 (4), p.523-535 |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Bacteriuria - epidemiology Bacteriuria - etiology Catheters Catheters, Indwelling - adverse effects Clinical trials Cystostomy Female Gynecologic Surgical Procedures Gynecology Humans Incidence Intermittent Urethral Catheterization - adverse effects Intubation Length of Stay Medicine Medicine & Public Health Meta-analysis Pain - etiology Randomized Controlled Trials as Topic Review Article Surgery Systematic review Urinary Catheterization - adverse effects Urinary Catheterization - methods Urinary tract diseases Urinary tract infections Urogenital system Urology |
| title | The incidence of urinary tract infection of different routes of catheterization following gynecologic surgery: a systematic review and meta-analysis of randomized controlled trials |
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