In our multiple columns on avoiding catheter-associated urinary tract infections (CAUTI’s), we’ve stressed that the most important “intervention” is avoiding the catheter in the first place. We’ve talked about when catheters are appropriate and when they are not but there have always been a few gray areas. One of those is whether urinary catheters are necessary in patients undergoing C-sections.
A new systematic review (Li 2010) addresses that very issue. They found 3 controlled trials (2 randomized, 1 nonrandomized) totaling slightly over 1000 patients. They found that not using a urinary catheter resulted in a significantly lower incidence of UTI’s. They also found patients without catheters had a lower rate of discomfort on first voiding, less time to first voiding, and less time until ambulation. At the same time there were no differences in rates of urinary retention, operating time, or intraoperative difficulties. Shorter hospital stays and lower costs may be other advantages of avoiding catheter use in C-section patients.
The authors do caution, however, that the studies reviewed had small numbers and varying degrees of methodological rigor. They suggest that larger well-designed randomized controlled trials should be undertaken.
Links to our other columns on urinary catheter-associated UTI’s:
L Li L, Wen J, Wang L, et al. Is routine indwelling catheterisation of the bladder for caesarean section necessary? A systematic review. BJOG 2010
Published online on Dec 23, 2010