Evaluation of use versus nonuse of urinary catheterization during Second Elective caesarean delivery: A Randomized Control Trial

Abstract

Catheterization of urinary bladder prior to caesarean section is a long-standing practice that has been continued for a long time without being subjected to critical evaluation (Senanayake, 2005). The main idea for catheterization is the belief that empty bladder is at less risk of damage during surgery than a distended one. A distended bladder is also expected to interfere with exposure of surgical field which makes surgery more difficult (Senanayake, 2005). The main disadvantage of catheterization is the increased risk of urinary tract infection (UTI) (Schwartz, 1999). Although the dictum that, the bladder should be catheterized in order to protect it from intraoperative injury, it could be said that a slightly filled bladder may be better demarcated, more easily identified and less vulnerable to injury. Even in the case of accidental cystotomy, urine will flow out from site of injury drawing attention to the damage. This would be more reliable and an earlier indicator of cystotomy than the other indirect methods such as postoperative haematuria (Senanayake, 2005). This study compares between the rates of UTI in second elective caesarean sections with and without urethral catheterization. This study also detects the effect of doing second elective caesarean section without urethral catheterization on intraoperative complication (bladder injuries), postoperative urine retention, time until ambulation, discomfrt at first void and length of hospital sty. This study as prospective randomized controlled trial carried out on 220 patients with written consent, undergoing second elective caesarean sections that were divided into two equal groups: Group Ι: It included 111 women who had undergone second elective caesarean section with urethral catheterization. Group ΙΙ: It included 109 women who had undergone second elective caesarean section without urethral catheterization. Both groups preoperatively were subjected to: 1. History. 2. Examination. 3. Investigation (urine analysis). All patients included in this trial were subjected to second caesarean section by the ordinary classic technique. Both groups postoperatively were subjected to: • Routine analgesia, fluids and nursing. • Evaluation of possible complications by: symptoms, signs and investigations (urine analysis and culture sensitivity if needed). In this study there was no statistically significant difference could be detected between both studied groups as regard the age, parity or gestational age. There was no statistically significant difference between both studied groups as regard the operative time or intraoperative complication (Bladder injury). The rate of postoperative urinary tract infection (UTI) was significantly higher in women of group I when compared to those of group II (33.33% in group I versus 6.54% in Group II) (p < 0.001). There was significant reduction in the time of ambulation (from the end of caesarean section till first ambulation) in group II. Reduction In the first void discomfort was detected in group II whose patients had undergone second elective caesarean section without urethral catheterization. In conclusion: the results of this randomized controlled trial demonstrated reduction in the incidence of UTI, reduction in the first void discomfort and early ambulation; when caesarean delivery was done without application of routine indwelling urinary catheter without affecting safety of procedure.