This prospective study was done to see if reducing transurethral Foley catheterization from 3 days to 1 would lead to fewer urinary tract infections without an increase in voiding problems. Ninety-one women undergoing retropubic surgery for stress urinary incontinence (Burch or Marshall-Marchetti-Krantz) were randomized to either 1 or 3 days' catheterization. Antibiotics were not used. Infection was diagnosed in 9 (20.0%) patients in the 1-day group and in 16 (34.8%) in the 3-day group. Delayed voiding occurred in 13 (28.9%) and 10 (21.7%) patients, respectively, and 5 (11.1%) and 3 (6.5%), respectively, received a new catheter. The differences do not reach statistical significance. Therefore, catheter time may safely be reduced to 1 day. This may lead to fewer infections but also somewhat more voiding problems. If a transurethral catheter is to be used, on balance the two regimens are equivalent.
Keywords Bacteriuria - Catheterization - Postoperative complications - Urinary incontinence - Urinary tract infection
Editorial Comment: The investigators present a simple and clearly defined study on postoperative voiding management, specifically comparing 1 and 3 day's transurethral Foley catheterization after retropubic surgery. The study is limited by insufficient numbers and the possibility of a type II error in comparing such a small difference in length of Foley use (1 versus 3 days), in terms of the incidence of urinary tract infection or voiding dysfunction. In spite of this limitation, the large number of surgeons utilizing transurethral Foley catheterization following retropubic procedures should find this study of interest, as should those who practise in a managed care environment. Removal of the Foley catheter on postoperative day 1 appears to be a viable alternative, as long as adequate bladder emptying is confirmed.