Systematic review of shorter versus longer duration of bladder catheterization after surgical repair of urinary obstetric fistula.

BACKGROUND

Bladder catheterization duration after urinary obstetric fistula surgery varies widely.

OBJECTIVE

To assess the effect of bladder catheterization duration after urinary obstetric fistula surgery.

SEARCH STRATEGY

Medline, EMBASE, CINAHL, GIM, and POPLINE databases were searched, without language restrictions, using "obstetric urinary fistula" and "catheterization" from inception to September 30, 2017.

SELECTION CRITERIA

Randomized controlled trials comparing shorter versus longer (>10 days) bladder catheterization after urinary obstetric fistula repair were included.

DATA COLLECTION AND ANALYSIS

Data were extracted and meta-analyses were conducted. The GRADE system was used to assess evidence quality.

MAIN RESULTS

Two unblinded non-inferiority trials (684 patients combined) were included. There were no differences between shorter and longer bladder catheterization in the risk of fistula repair breakdown either before (relative risk [RR] 1.14; 95% confidence interval [CI] 0.49-2.64) or after (RR 1.64; 95% CI 0.81-3.31) hospital discharge. Similarly, urinary infection (RR 5.18; 95% CI 0.25-107.44); urinary incontinence before (RR 1.15; 95% CI 0.54-2.43) or after (RR 1.16; 95% CI 0.62-2.18) discharge; urinary retention (RR 1.34; 95% CI 0.79-2.27); or extended hospital stay (RR 9.33; 95% CI 0.51-172.41) were not associated with duration of catheterization. Evidence quality was low or moderate.

CONCLUSIONS

Shorter, compared to longer, bladder catheterization duration after urinary obstetric fistula surgery was not associated with significant outcome differences.