Bladder training prior to urinary catheter removal in total joint arthroplasty. A randomized controlled trial

Effect of intermittent urethral catheter clamping combined with active urination training (ICCAUT) strategy on postoperative urinary dysfunction after radical rectal cancer surgery: single-centre randomised controlled trial (ICCAUT -1) study protocol

BACKGROUND

Urinary catheter placement is routinely performed after proctectomy. However, there is uncertainty regarding the need for bladder training before catheter removal. This trial aims to examine the effect of intermittent catheter clamping combined with active urination training (ICCAUT) on urinary retention and secondary catheterisation after proctectomy.

METHODS AND ANALYSIS

Eligible patients will be randomly assigned in a 1:1 ratio to either the ICCAUT group or the free-drainage (FD) group. In the ICCAUT group, patients will undergo intermittent clamping of the urinary catheter combined with active urination training before its removal, whereas the patients in the FD group will not receive any specific training. The urinary catheter will be removed on postoperative day 2 in both groups after emptying the bladder. The primary end point is the incidence of urinary dysfunction. Secondary end points include urinary tract infection, time to first urination after catheter removal, catheter-related bladder discomfort syndrome, postoperative morbidity and mortality and urinary function within 30 days.

ETHICS AND DISSEMINATION

This trial was approved by the Ethics Review Committee of the First Hospital of Jilin University (24K047-001). Written informed consent will be obtained before performing any study procedures. All primary and secondary outcomes will be reported in peer-reviewed publications and at conference presentations.

TRIAL REGISTRATION NUMBER

The trial was registered at ClinicalTrials.gov website, NCT06241703.

Intermittent catheter clamping combined with active urination training (ICCAUT) to reduce the risk of urinary dysfunction in patients after proctectomy: a single-center cohort study

BACKGROUND

Intermittent urethral catheter clamping is widely used to reduce secondary catheterization in patients after proctectomy; however, its effectiveness is unclear.

MATERIALS AND METHODS

This study investigated the effects of intermittent catheter clamping combined with active urination training (ICCAUT) on postoperative urinary dysfunction in patients after proctectomy. This retrospective cohort study analyzed data on patients who underwent laparoscopic/robotic-assisted proctectomy at a single medical center in China between July 2023 and January 2024.

METHODS

Patients received ICCAUT or free urinary drainage during the indwelling urethral catheter period after surgery. Data from the ICCAUT and free-drainage groups were compared. The primary outcome measure was urinary dysfunction. The secondary outcomes were urinary tract infections, time to first void after catheter removal, and urine volume during first voiding. Propensity-score matching (PSM), inverse probability-of-treatment weighting (IPTW), and multivariable logistic regression analyses were used to identify factors associated with urinary dysfunction.

RESULTS

Among 360 eligible patients, 173 received a free-drainage strategy and 187 received ICCAUT. The incidence of urinary dysfunction was 52.5% overall and was significantly lower in the ICCAUT group than in the free-drainage group (45.1% vs. 59.4%; p = 0.009). The lower incidence of urinary dysfunction in the ICCAUT group was confirmed in the PSM (44.7% vs. 59.3%; p = 0.03) and IPTW (44.5% vs. 57.1%; p = 0.028) analyses. Multivariable logistic regression analysis revealed that ICCAUT was independently associated with a lower risk of urinary dysfunction (OR, 0.55; 95% CI, 0.34-0.89; p = 0.015). Subgroup analysis found that, compared with female patients, male patients are more likely to benefit from the ICCAUT strategy (p for interaction = 0.029; adjusted OR, 0.33; 95% CI, 0.17-0.62; p < 0.001). The ICCAUT strategy did not significantly increase the risk of urinary tract infection (p = 0.349).

CONCLUSIONS

The ICCAUT strategy may benefit the recovery of urinary function after proctectomy, especially for male patients. ICCAUT showed an independent association with a lower risk of urinary dysfunction and UTI, with urinary tract infection comparable to that of the free-drainage strategy.

Efficacy and safety of electroacupuncture for urinary retention: A systematic review and meta-analysis

BACKGROUND

Electroacupuncture (EA) is considered as an effective treatment for urinary retention (UR).

METHODS

Up to April 7, 2023, randomized controlled trials (RCTs) of EA for UR were extensively searched in 8 databases, including Pubmed, Cochrane, Embase, Web of Science, Chinese Biomedical Literature Database, Chinese Journal Full-text Database, Wanfang Data, and VIP Full-text e-Journals Database. The Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) were utilized to evaluate the quality of all included RCTs. Meta-analysis was conducted using Stata 15.0 software.

RESULTS

A total of 23 trials were included, and the meta-analysis results suggested that compared with the control group, EA can effectively treat various types of UR (risk ratio [RR] = 1.22, 95CI%: 1.14, 1.31) and promote bladder function recovery, with a significant reduce in residual urine volume (weighted mean differences [WMD] = -49.60, 95CI%: -64.10, -35.11), an increase in maximum bladder capacity (WMD = 47.00, 95CI%: 12.76, 81.24), a shorten in the first urination time (standardized mean difference [SMD] = -1.42, 95CI%: -2.08, -0.76), and less adverse reactions (RR = 0.21, 95CI%: 0.07, 0.65).

CONCLUSION

EA has significant advantages in treating UR, but the efficacy and safety are still needed to be further verified through large-sample and high-quality RCTs.

Association between diabetes mellitus and postoperative urinary retention after cerebral angiography

AIMS

The aim of this study is to examine the association between diabetes mellitus and postoperative urinary retention on cerebral angiography (including intravascular interventional therapy).

METHODS

We collected data on the demographic characteristics and comorbidities, imaging and routine laboratory data, surgical information, and medications of patients who underwent cerebral angiography. Multivariate logistic regression was used to explore the correlation between diabetes and the incidence of postoperative urinary retention.

RESULTS

A total of 932 patients were included, with a mean age of 59.7 years (74.1% men). Postoperative urinary retention occurred in 40.8% of the diabetes mellitus group and 30.3% of the group without diabetes. Compared with the group without diabetes, those with diabetes were more likely to experience postoperative urinary retention. Patients with higher glycosylated hemoglobin A1c levels had a higher risk of developing postoperative urinary retention.

CONCLUSIONS

Diabetes was independently linked to postoperative urinary retention following cerebral angiography and patients with glycosylated hemoglobin A1c levels > 6% were more likely to experience postoperative urinary retention. Therefore, clinically regulating blood glucose levels may help to reduce the likelihood of postoperative urinary retention after cerebral angiography.

Need to clamp indwelling urinary catheters before removal after different durations: a systematic review and meta-analysis

OBJECTIVE

This meta-analysis aimed to evaluate the effect of bladder training by clamping on bladder urethral function in patients with indwelling urinary catheters used for different durations.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

The UpToDate, Cochrane Library, OVID, PubMed, China National Knowledge Infrastructure, CINAHL and Embase were screened from 1 January 2000 to 28 February 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Randomised controlled trials (RCTs) or quasi-experimental designs comparing the efficacy of bladder training in patients with an indwelling urinary catheter by clamping or free drainage before urinary catheter removal were published in English or Chinese.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted the data and assessed the quality of studies. Continuous variables were analysed using mean difference and standardised mean difference (SMD) values with a 95% CI. Categorical variables were analysed using relative risk (RR) and 95% CI.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was urinary tract infection incidence, and secondary outcomes included hours to first voiding, incidence of urinary retention and recatheterisation and residual urine volume.

RESULTS

Seventeen papers (15 RCTs and 2 quasi-RCTs) comprising 3908 participants were included in the meta-analysis. The pooled results of the meta-analysis showed that the clamping group had a significantly higher risk of urinary tract infections (RR=1.47; 95% CI 1.26 to 1.72; p<0.00001) and a longer hour to first void (SMD=0.19; 95% CI 0.08 to 0.29; p=0.0004) compared with the free drainage group. Subgroup analysis of indwelling urinary catheter use durations of ≤7 days indicated that clamping significantly increased the risk of urinary tract infection (RR=1.69; 95% CI 1.42 to 2.02, p<0.00001) and lengthens the interval to first void (SMD=0.26, 95% CI 0.11 to 0.41, p=0.0008) compared with free drainage.

CONCLUSIONS

Bladder training by clamping indwelling urinary catheters increases the incidence of urinary tract infection and lengthens the hours to first void in patients with indwelling urinary catheters use durations of ≤7 days compared with the free drainage. However, the effect of clamping training on patients with an indwelling urinary catheter use duration of >7 days is unclear.

Impact of early postoperative indwelling urinary catheter removal: A systematic review

BACKGROUND

Indwelling urinary catheters (IDUCs) are associated with complications and early removal is therefore essential. Currently, it is unknown what the effect of a specific removal time is and what the consequences of this removal time are.

RESEARCH QUESTION

To present an overview of the available evidence to determine the effects of three postoperative IDUC removal times (after a certain number of hours, at a specific time of day and flexible removal time) on the development of complications in hospital.

METHODS

PubMed, Medline, Embase, Emcare and Cochrane Central Register of Controlled Trials were searched till 6 June, 2021. Studies were included that described the effect of the removal time in relation to re-catheterisation, urinary tract infections (UTIs), ambulation time, time of first voiding and hospital stay. The quality of the studies was assessed with the Newcastle-Ottawa Scale and the Cochrane Effective Practice and Organisation of Care. A narrative descriptive analysis was performed. PRISMA guidelines were followed in reporting this review.

RESULTS

Twenty studies were included from which 18 compared removal after a number of hours, 1 reported on a specific removal time and 1 reported on both topics. The results were contradicting regarding the hypothesis that later removal increases the incidence of UTIs. Earlier removal does not lead to a higher re-catheterisation rate while immediate removal is beneficial for reducing the time to first ambulation and shortening the hospital stay. Studies reporting on specific removal times did not find differences in outcomes. No study addressed flexible removal time.

CONCLUSIONS

There is inconclusive evidence that earlier removal results in less UTIs, despite the incidence of UTIs increasing if the IDUC is removed ≥24 h. Immediate or after 1-2 day(s) removal does not lead to higher re-catheterisation rates while immediate removal results in earlier ambulation and shorter length of hospital stay.

IMPLICATIONS OF KEY FINDINGS

Nurses should focus on early IDUC removal while being aware of urinary retention.

Effectiveness of Acupuncture on Urinary Retention: A Meta-Analysis

Objectives

This study aimed to evaluate the safety and efficacy of acupuncture in the treatment of urinary retention (UR).

Methods

Randomized controlled trials investigating the effectiveness of acupuncture in the treatment of UR were identified by searching seven comprehensive databases (Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, and Chinese Biomedical Literature Database) prior to September 2020. Data analysis was performed using RevMan, version 5.3, and Stata software, version 14.0.

Results

A total of 12 studies with 979 participants were included. A random-effects model was used to conduct a meta-analysis on the acupuncture group and the control group. The results show that acupuncture can effectively promote spontaneous urination and reduce anxiety in patients with poor urination (relative risk: 1.35; 95% confidence interval (CI): 1.19–1.53; P < 0.00001). The random-effects model showed significant differences in residual urine volume between the acupuncture group and the control group (MD: −84.79, 95% CI: −135.62 to −33.94; P=0.001).

Conclusion

Acupuncture is safe and effective in the treatment of UR. However, since the current level of evidence is limited, high-quality, large-sample, multi-center, clinical randomized controlled trials are needed to further confirm our conclusions in the future.

Urinary retention after total joint arthroplasty of hip and knee: Systematic review

PURPOSE

Postoperative urinary retention (POUR) is a common complication after total joint arthroplasties (TJAs). The POUR is managed with urinary catheterization, which is associated with a risk of urinary tract infection and subsequent periprosthetic joint infection. The purpose of this review was to afford a comprehensive understanding of POUR and its management.

METHODS

We identified 15 original articles concerning POUR after TJA, which were published from January 2010 to February 2019. The diagnostic method, incidence, risk factors, and management of POUR of the 15 studies were reviewed.

RESULTS

The incidence of POUR was ranged from 4.1% to 46.3%. Ultrasound was used for the detection of POUR among the total of the 15 studies. The following factors of old age, male gender, benign prostatic hypertrophy, history of urinary retention, spinal/epidural anesthesia, excessive fluid administration, patient-controlled analgesia, the use of opiates, underlying comorbidities, and poor American Society of Anesthesiologists (ASA) grade were risk factors for POUR. Most of the studies did not use indwelling catheterization during surgery. The POUR patients were managed with intermittent catheterization. The most common volume criterion for bladder catheterization was 400 mL. In inevitable use of an indwelling catheter, it should be removed within 48 h.

CONCLUSIONS

This review provided an up-to-date guide for the detection and management of POUR.

LEVEL OF EVIDENCE

Level III.