Graduate Entry Medical School, University of Limerick, and National Maternity Hospital, Dublin, Ireland.
Obstet Gynecol. 2012 Sep;120(3):678-87. doi: 10.1097/AOG.0b013e3182657f0d.
Suprapubic catheterization is commonly used for postoperative bladder drainage after gynecologic procedures. However, recent studies have suggested an increased rate of complications compared with urethral catheterization. We undertook a systematic review and meta-analysis of randomized controlled trials comparing suprapubic catheterization and urethral catheterization in gynecologic populations.
PubMed, EMBASE, CINAHL, Google Scholar, and trial registries were searched from 1966 to March 2012 for eligible randomized controlled trials comparing postoperative suprapubic catheterization and urethral catheterization in gynecologic patients. We used these search terms: "catheter," "supra(-)pubic catheter," "urinary catheter," "gyn(a)ecological," "catheterization techniques gyn(a)ecological surgery," "transurethral catheter," and "bladder drainage." No language restrictions were applied. METHODS AND STUDY SELECTION: The primary outcome was urinary tract infection. Secondary outcomes were the need for recatheterization, duration of catheterization, catheter-related complications, and duration of hospital stay. Pooled effect size estimates were calculated using the random effects model from DerSimonian and Laird.
TABULATION, INTEGRATION, AND RESULTS: In total, 12 eligible randomized controlled trials were included in the analysis (N=1,300 patients). Suprapubic catheterization was associated with a significant reduction in postoperative urinary tract infections (20% compared with 31%, pooled odds ratio [OR] 0.31, 95% confidence interval [CI] 0.185-0.512, P<.01) but an increased risk of complications (29% compared with 11%, pooled OR 4.14, 95% CI 1.327-12.9, P=.01). Complications were mostly related to catheter tube malfunction with no visceral injuries reported. No differences in the rate of recatheterization or hospital stay were demonstrated. Robust patient satisfaction and cost-effectiveness data are lacking.
Based on the best available evidence, no route for bladder drainage in gynecologic patients is clearly superior. The reduced rate of infective morbidity with suprapubic catheterization is offset by a higher rate of catheter-related complications and crucially does not translate into reduced hospital stay. As yet, there are insufficient data to determine which route is most appropriate for catheterization; therefore, cost and patient-specific factors should be paramount in the decision. Minimally invasive surgery may alter the requirement for prolonged postoperative catheterization.
耻骨上导尿术常用于妇科手术后的膀胱引流。然而，最近的研究表明，与尿道导尿相比，其并发症发生率更高。我们对比较妇科人群中耻骨上导尿和尿道导尿的随机对照试验进行了系统评价和荟萃分析。
从 1966 年至 2012 年 3 月，我们检索了 PubMed、EMBASE、CINAHL、Google Scholar 和试验注册处，以寻找比较妇科患者术后耻骨上导尿和尿道导尿的随机对照试验。我们使用了以下搜索词：“导管”、“耻骨上导管”、“导尿管”、“妇科”、“妇科手术导管技术”、“经尿道导管”和“膀胱引流”。未应用语言限制。
主要结局是尿路感染。次要结局包括需要重新导尿、导尿管留置时间、导管相关并发症和住院时间。使用 DerSimonian 和 Laird 的随机效应模型计算汇总效应大小估计值。
表格、综合和结果：共有 12 项符合条件的随机对照试验（N=1300 例患者）纳入分析。耻骨上导尿术与术后尿路感染显著减少相关（20%比 31%，汇总比值比[OR]0.31，95%置信区间[CI]0.185-0.512，P<.01），但并发症风险增加（29%比 11%，汇总 OR 4.14，95% CI 1.327-12.9，P=.01）。并发症主要与导管管功能障碍有关，无内脏损伤报告。未发现重新导尿或住院时间的差异。缺乏稳健的患者满意度和成本效益数据。
根据现有最佳证据，妇科患者中没有一种膀胱引流方法明显优于其他方法。耻骨上导尿术降低感染发病率的优势被更高的导管相关并发症发生率所抵消，关键是不会导致住院时间缩短。目前，尚无足够的数据确定哪种途径最适合导尿；因此，成本和患者特定因素应在决策中占主导地位。微创外科可能改变对术后长期导尿的需求。
