Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
BJS Open. 2020 Aug;4(4):545-553. doi: 10.1002/bjs5.50288. Epub 2020 May 7.
Urinary catheters are placed after rectal surgery to prevent urinary retention, but prolonged use may increase the risk of urinary tract infection (UTI). This review evaluated the non-inferiority of early urinary catheter removal compared with late removal for acute urinary retention risk after rectal surgery.
MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from January 1980 to February 2019. RCTs comparing early versus late catheter removal after rectal surgery were eligible. Primary outcomes were acute urinary retention and UTI; the secondary outcome was length of hospital stay. Early catheter removal was defined as removal up to 2 days after surgery, with late removal after postoperative day 2. The non-inferiority margin from an included trial was used for analysis of change in urinary retention (Δ = 15 per cent). Pooled estimates of risk differences (RDs) were derived from random-effects models. Risk of bias was assessed using a modified Cochrane risk-of-bias tool.
Four trials were included, consisting of 409 patients. There was insufficient evidence to conclude non-inferiority of early versus late catheter removal for acute urinary retention (RD 9 (90 per cent c.i. -1 to 19) per cent; P = 0·31). Early catheter removal was superior for UTI (RD -11 (95 per cent c.i. -17 to -4) per cent; P = 0·001). Results for length of stay were mixed. There were insufficient data to conduct subgroup analyses.
The existing literature is inconclusive for non-inferiority of early versus late urinary catheter removal for acute urinary retention. Early catheter removal is superior in terms of reducing the risk of UTI.
直肠手术后放置导尿管以预防尿潴留，但长时间留置可能会增加尿路感染（UTI）的风险。本综述评估了与直肠手术后晚期拔除导尿管相比，早期拔除导尿管对急性尿潴留风险的非劣效性。
从 1980 年 1 月至 2019 年 2 月，检索 MEDLINE、Embase 和 Cochrane 对照试验中心注册库。合格的 RCT 比较了直肠手术后早期与晚期拔除导尿管。主要结局为急性尿潴留和 UTI；次要结局为住院时间。早期导尿管拔除定义为术后 2 天内拔除，晚期导尿管拔除定义为术后第 2 天以后拔除。使用纳入试验的非劣效性边界进行尿潴留变化的分析（Δ = 15%）。来自随机效应模型的风险差异（RD）的汇总估计值。使用改良 Cochrane 风险偏倚工具评估偏倚风险。
共有 4 项试验纳入了 409 名患者。对于急性尿潴留，早期与晚期导管拔除的非劣效性证据不足（RD 9%（90%置信区间-1 至 19）；P=0.31）。早期导管拔除在 UTI 方面具有优势（RD-11%（95%置信区间-17 至-4）；P=0.001）。住院时间的结果不一。没有足够的数据进行亚组分析。
现有文献对于急性尿潴留的早期与晚期导尿管拔除的非劣效性尚无定论。早期拔除导尿管可降低 UTI 的风险。
