Document Type : Original Article
Authors
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MBBCh, Medicine and Surgery, Faculty of Medicine and Surgery, October 6 University, Giza, Egypt. 2 International Medical Students Research Association
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International Medical Students Research Association. MBBCh, Medicine and Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
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International Medical Students Research Association. MBBCh, Medicine and Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
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International Medical Students Research Association. MBBCh, Medicine and Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Minia Medical Research Society (MMRS), Minia University, Egypt Department of Medicine and Surgery, Faculty of Medicine
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MBBCh, Medicine and Surgery, Faculty of Medicine and Surgery, October 6 University, Giza, Egypt. International Medical Students Research Association
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Faculty of Pharmacy, Minia University, Egypt. Minia Medical Research Society (MMRS), Minia University, Egypt
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Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Abstract
Introduction: There is no standard time for removing urinary catheters after pelvic organ prolapse (POP) surgeries and vaginal hysterectomy. We aimed to synthesize evidence about the benefits of early versus delayed catheter removal in decreasing post-operative complications after POP surgeries and vaginal hysterectomy.
Material and Methods: We searched the literature from inception till April 2019 using PubMed, Web of Science, Scopus, WHO Global Health Library (GHL), Virtual Health Library (VHL), System for Information on Grey Literature in Europe (SIGLE), POPLINE, and Cochrane Central Register of Controlled Trials (CENTRAL). We screened the retrieved records for their eligibility and extracted baseline and outcomes data. We performed quality assessment using the Cochrane risk of bias assessment tool. continuous data were pooled as mean difference (MD) and dichotomous data as relative risk (RR) with their corresponding 95% confidence intervals (CIs) in a random-effects model. We analyzed data using Review Manager 5.3 for windows.
Results: Nine studies (N= 1116 patients) were included in the final meta-analysis. Overall effect estimates favored early catheter removal group in comparison to delayed catheter removal group in the following outcomes; Urinary tract infection (UTI) (RR=0.42, 95% CI [0.24, 0.72], P=0.0002), Symptomatic urinary tract infection (SUTI) (RR=0.23, 95% CI [0.11, 0.48], P=0.0001), length of hospitalization (MD= -0.89, 95% CI [-1.26, -.52], P=0.0001). Whereas, the pooled effect estimates favored delayed removal group over the early removal group regarding re-catheterization (RR=2.75, 95% CI [1.86, 4.07], P=0.0001). There was no significant difference between the two groups regarding urinary retention (RR=1.45, 95% CI [0.80, 2.63], P=0.22).
Conclusion: Early catheter removal is better than delayed catheter removal in decreasing the risk of urinary tract infection, symptomatic urinary tract infection, the length of hospitalization. However, delayed catheter removal reduced post-operative re-catheterization events. The risk of urinary retention was comparable in the two study groups.
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