Immediate, 6-hours and 24-hours urethral catheter removal on urinary morbidity following elective caesarean delivery under spinal anaesthesia: A randomized comparative study.
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Keywords
Caesarean delivery, Urethral Catheterisation, Urinary tract Infections, Urinary retention, Maternal discomfort, Significant bacteriuria, Spinal anaesthesia
Abstract
Background: Urethral catheterization is a common practice during caesarean delivery. Prolonged use may lead to urinary tract infection, the duration of catheterization being critical to its development. The optimal time for its removal after caesarean delivery remains undecided. This study compared the effect of immediate, 6-hours and 24-hours removal post-elective caesarean delivery on significant bacteriuria, re-catheterisation, interval to first micturition and maternal discomfort.
Methodology: The study was conducted at a tertiary hospital in Port Harcourt, Nigeria. A total of 150 women who had elective caesarean delivery were randomised into 3 groups using computer-generated random sequence numbers. Group A – had the urethral catheter removed immediately, Group B – after 6 hours, and Group C – after 24 hours post-operation. The women were assessed for significant bacteriuria and need for re-catheterisation as the primary outcomes; interval to first micturition and maternal discomfort as the secondary outcomes. Data was analysed using IBM SPSS version 23.
Results: Overall incidence of significant bacteriuria was 12%. The difference in incidence was 0(0%), 6(12%), and 12(24%) for the Immediate, 6-hours and 24-hours groups respectively,(p<0.001).Urinary retention requiring re-catheterization was also significant, highest in the Immediate group 8(14%), 2(4%) in the 6-hours group and none in the 24-hours group. The mean interval to first micturition was highest in the 6-hour group, least in the 24-hour group and intermediate in the Immediate group (9.52±6.26, 5.16±3.80, and 6.92±3.36, respectively<0.001). Most participants had mild discomfort, and the difference between groups was insignificant (p=0.445).
Conclusion: Immediate catheter removal had a lower risk of significant bacteriuria but increased urinary retention, while the 24-hour removal had reduced urinary retention but was fraught with significant bacteriuria. The 6-hour removal had a modest risk for both significant bacteriuria and urinary retention. The 6-hours removal offers a balance and should be a safer option.
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