The effect of clamping the indwelling urinary catheter before removal in cervical cancer patients after radical hysterectomy

Timing of Trial of Void After Radical Hysterectomy: Long-Term Urinary Outcomes at Two Academic Tertiary Care Institutions

INTRODUCTION AND HYPOTHESIS

Many patients develop bladder symptoms after radical hysterectomy. This study compared urinary outcomes following radical hysterectomy based on trial of void (TOV) timing (pre-discharge TOV versus post-discharge TOV).

METHODS

A retrospective non-inferiority study of patients at two academic tertiary referral centers who underwent radical hysterectomy between January 2010 and January 2020 was carried out. Patients were stratified according to timing of postoperative TOV: either pre-discharge or post-discharge from the hospital. Short-term urinary outcomes (including passing TOV, representation with retention) and long-term de novo urinary dysfunction (defined as irritative voiding symptoms, urgency, frequency, nocturia, stress or urgency incontinence, neurogenic bladder, and/or urinary retention) were extracted from the medical record. We hypothesized that the proportion of patients who failed pre-discharge TOV would be within a 15% non-inferiority margin of post-discharge TOV.

RESULTS

A total of 198 patients underwent radical hysterectomy for cervical (118 out of 198; 59.6%), uterine (36 out of 198; 18.2%), and ovarian (29 out of 198; 14.6%) cancer. One hundred and nineteen patients (119 out of 198, 60.1%) underwent pre-discharge TOV, of whom 14 out of 119 (11.8%) failed. Of the post-discharge TOV patients (79 out of 198, 39.9%), 5 out of 79 (6.3%) failed. The proportion of patients who failed a pre-discharge TOV was within the non-inferiority margin (5.4% difference, p = 0.23). A greater proportion of patients in the post-discharge TOV group developed long-term de novo urinary dysfunction (27.2% difference, p = 0.005). Median time to diagnosis of de novo urinary dysfunction was 0.5 years (range 0-9) in the pre-discharge TOV group versus 1.0 year (range 0-6) in the post-discharge TOV group (p > 0.05).

CONCLUSIONS

In this study, pre-discharge TOV had non-inferior short-term outcomes and improved long-term outcomes.

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.

A retrospective controlled study of postoperative fever after posterior lumbar interbody fusion due to degenerative lumbar disease

BACKGROUND

Postoperative fever is a common feature of spinal surgery. When fever occurs postoperatively in patients, surgeons are eager to rule out an infection. There are many reports about postoperative fever and infection; however, only a few have described the relationship between degenerative spinal disease and postoperative fever. This study aimed to investigate the causes of postoperative fever in patients with degenerative lumbar disease undergoing posterior screw fixation and interbody fusion and compare patients with non-pathologic fever and infected febrile patients.

METHODS

From March 2015 to February 2016, 263 patients with degenerative lumbar disease underwent posterior lumbar screw fixation and interbody fusion surgery in our institution. We performed risk factor analysis by categorizing patients as afebrile and febrile. Comparisons were made between afebrile patients and patients with non-pathologic fever, and an analysis was performed between patients with non-pathologic fever and patients with febrile infection. We compared each group by examining the demographic factors before surgery, surgery features, drain duration, and postoperative transfusion. The postoperative day (POD) of fever onset, postoperative fever duration, and blood sample results in patients with fever were investigated.

RESULTS

The drain duration was found to be an important factor between the afebrile febrile groups and between the non-pathologic fever and afebrile groups. POD of fever occurred earlier in the non-pathologic group than in the infection group (p = 0.04), and the duration of fever was shorter in the non-pathologic fever group than in the infection group (p = 0.01). Higher procalcitonin levels were observed at POD 5 in the infection group than in the non-pathologic fever group. (p < 0.01) The accidental dural rupture rate was higher in the infected group (p = 0.02); this was thought to be caused by the long non-ambulatory period after surgery.

CONCLUSION

This study identified risk factors and differences between infectious diseases associated with postoperative fever. A significant risk factor for postoperative non-pathological fever was a shorter catheter drainage period. Fever after 3 days, fever for more than 4 days and higher procalcitonin levels after surgery suggest infection.

Effect of urinary catheter removal on different time after hysterectomy: a network meta-analysis

INTRODUCTION AND HYPOTHESIS

The optimal timing for removing urinary catheters is controversial for patients undergoing total hysterectomy. This study aimed to evaluate the optimal time for removing urinary catheters post-hysterectomy.

METHODS

We searched multiple databases from inception till December 31, 2020, for all randomized trials evaluating the timing of catheter removal following hysterectomy. All studies were evaluated by two investigators independently depending on inclusion and exclusion criteria. Network meta-analysis (NMA) was conducted on the data using Stata 14.0 software.

RESULTS

A total of 12 articles involving 1814 patients were ultimately included. This study showed removing urinary catheters 12.1 to 24 h (pooled OR = 2.67; 95% CI, 1.53‑4.67) and 36.1 to 48 h (pooled OR = 8.11;95% CI, 3.78‑17.36) post-hysterectomy increased the risk of urinary tract infection (UTI) compared with immediate catheter removal. Timing of catheter removal in other groups following hysterectomy accompanied a reduced risk of urinary retention (UR) versus immediate catheter removal (P < 0.05). Removal of the urinary catheter from 36.1 to 48 h was most likely to lead to UTI. The maximum SUCRA value of immediate catheter removal after hysterectomy was 99.3% for UR. Catheter removal 24.1 to 36 h after hysterectomy was the best time for preventing UR.

CONCLUSION

Removal of the catheter immediately after hysterectomy may be the optimal time for preventing UTI with increased risk of UR, whereas removal time of the urinary catheters within 6 h post-hysterectomy combined with postoperative urination monitoring might be more beneficial than other removal times following hysterectomy.

Long-Term Effect of Early Post-operative Transcutaneous Electrical Stimulation on Voiding Function After Radical Hysterectomy: A Multicenter, Randomized, Controlled Trial

Introduction: Post-radical-hysterectomy (RH) patients suffer from a series of problems resulting from neurovascular injury, such as bladder dysfunction, which reduce their quality of life. We have designed this study to evaluate the efficacy of transcutaneous electrical stimulation (TENS) on patient rehabilitation after RH for early cervical cancer.

Materials and methods: A total of 97 patients were enrolled in a randomized-controlled trial (from January 2015 to December 2019) involving 7 medical centers nationwide. Patients were assigned to either the intervention group (n = 46), or the control group (n = 51). TENS was given to patients in the intervention group from the 7^th day after surgery for a total of 14–21 days. The control group received no TENS. Primary outcomes were measured for residual urine volume and recovery of urination function. Secondary outcomes were measures for urodynamics (UDS), pelvic floor electromyography function examination (PFEmF), and quality of life (QoL).

Results: Residual urine volume and improvement in the rate of urination were found to show no significant differences on the 14^th, 21^st, and 28^th days after surgery. The maximum flow rate (Qmax) in the intervention group was significantly higher than that in the control group on the 28^th day, but there were no significant differences in average flow rate, voiding time, time to Qmax, muscle fiber strength, muscle fiber fatigue, and the abnormal rate of A3 reflection on the 28^th day and the 3^rd mo., as well as in the QoL at 3^rd mo., 6^th mo., and 12^th mo. after surgery.

Conclusion: Our study showed no sufficient evidence to prove that TENS under the trialed parameters could improve the subject's voiding function, PFEmF, and QOL after RH. This has provided valuable data for rehabilitation after RH.

Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02492542.

Catheter-Associated Urinary Tract Infections in the Adult Patient Group: A Qualitative Systematic Review on the Adopted Preventative and Interventional Protocols From the Literature

Catheter-associated urinary tract infections (CA-UTIs) are among the most common nosocomial infections acquired by patients in health care settings. A significant risk factor for CA-UTIs is the duration of catheterization. To summarize the current strategies and interventions in reducing urinary tract infections associated with urinary catheters, use and the need for re-catheterization on the rate of CA-UTIs, we performed a systematic review. A rapid evidence analysis was carried out in the Medline (via Ovid) and the Cochrane Library for the periods of January 2005 till April 2021. The main inclusion criterion required to be included in this review was symptomatic CA-UTI in adults as a primary or secondary outcome in all the included studies. Only randomized trials and systematic reviews were included, reviewed, evaluated, and abstracted data from the 1145 articles that met the inclusion criteria. A total of 1145 articles were identified, of which 59 studies that met the inclusion criteria were selected. Studies of relevance to CA-UTIs were based on: duration of catheterization, indication for catheterization, catheter types, UTI prophylaxis, educational proposals and approaches, and mixed policies and interventions. The duration of catheterization is the contributing risk factor for CA-UTI incidence; longer-term catheterization should only be undertaken where needed indications. The indications for catheterization should be based on individual base to base cases. The evidence for systemic prophylaxis instead of when clinically indicated is still equivocal. However, antibiotic-impregnated catheters reduce the risk of symptomatic CA-UTIs and bacteriuria and are more cost-effective than other impregnated catheter types. Antibiotic resistance, potential side effects and increased healthcare costs are potential disadvantages of implementing antibiotic prophylaxis. Multiple interventions and measures such as reducing the number of catheters in place, removing catheters at their earliest, clinically appropriate time, reducing the number of unnecessary catheters inserted, decrease antibiotic administration unless clinically needed, raising more awareness and provide training of nursing personnel on the latest guidelines, can effectively lower the incidence of CA-UTIs.

Strategies for the removal of short-term indwelling urethral catheters in adults

BACKGROUND

Urinary catheterisation is a common procedure, with approximately 15% to 25% of all people admitted to hospital receiving short-term (14 days or less) indwelling urethral catheterisation at some point during their care. However, the use of urinary catheters is associated with an increased risk of developing urinary tract infection. Catheter-associated urinary tract infection (CAUTI) is one of the most common hospital-acquired infections. It is estimated that around 20% of hospital-acquired bacteraemias arise from the urinary tract and are associated with mortality of around 10%. This is an update of a Cochrane Review first published in 2005 and last published in 2007.

OBJECTIVES

To assess the effects of strategies for removing short-term (14 days or less) indwelling catheters in adults.

SEARCH METHODS

We searched the Cochrane Incontinence Specialised Register, which contains trials identified from CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP, and handsearching of journals and conference proceedings (searched 17 March 2020), and reference lists of relevant articles.

SELECTION CRITERIA

We included all randomised controlled trials (RCTs) and quasi-RCTs that evaluated the effectiveness of practices undertaken for the removal of short-term indwelling urethral catheters in adults for any reason in any setting.

DATA COLLECTION AND ANALYSIS

Two review authors performed abstract and full-text screening of all relevant articles. At least two review authors independently performed risk of bias assessment, data abstraction and GRADE assessment.

MAIN RESULTS

We included 99 trials involving 12,241 participants. We judged the majority of trials to be at low or unclear risk of selection and detection bias, with a high risk of performance bias. We also deemed most trials to be at low risk of attrition and reporting bias. None of the trials reported on quality of life. The majority of participants across the trials had undergone some form of surgical procedure. Thirteen trials involving 1506 participants compared the removal of short-term indwelling urethral catheters at one time of day (early morning removal group between 6 am to 7 am) versus another (late night removal group between 10 pm to midnight). Catheter removal late at night may slightly reduce the risk of requiring recatheterisation compared with early morning (RR 0.71, 95% CI 0.53 to 0.96; 10 RCTs, 1920 participants; low-certainty evidence). We are uncertain if there is any difference between early morning and late night removal in the risk of developing symptomatic CAUTI (RR 1.00, 95% CI 0.61 to 1.63; 1 RCT, 41 participants; very low-certainty evidence). We are uncertain whether the time of day makes a difference to the risk of dysuria (RR 2.20; 95% CI 0.70 to 6.86; 1 RCT, 170 participants; low-certainty evidence). Sixty-eight trials involving 9247 participants compared shorter versus longer durations of catheterisation. Shorter durations may increase the risk of requiring recatheterisation compared with longer durations (RR 1.81, 95% CI 1.35 to 2.41; 44 trials, 5870 participants; low-certainty evidence), but probably reduce the risk of symptomatic CAUTI (RR 0.52, 95% CI 0.45 to 0.61; 41 RCTs, 5759 participants; moderate-certainty evidence) and may reduce the risk of dysuria (RR 0.42, 95% CI 0.20 to 0.88; 7 RCTs; 1398 participants; low-certainty evidence). Seven trials involving 714 participants compared policies of clamping catheters versus free drainage. There may be little to no difference between clamping and free drainage in terms of the risk of requiring recatheterisation (RR 0.82, 95% CI 0.55 to 1.21; 5 RCTs; 569 participants; low-certainty evidence). We are uncertain if there is any difference in the risk of symptomatic CAUTI (RR 0.99, 95% CI 0.60 to 1.63; 2 RCTs, 267 participants; very low-certainty evidence) or dysuria (RR 0.84, 95% CI 0.46 to 1.54; 1 trial, 79 participants; very low-certainty evidence). Three trials involving 402 participants compared the use of prophylactic alpha blockers versus no intervention or placebo. We are uncertain if prophylactic alpha blockers before catheter removal has any effect on the risk of requiring recatheterisation (RR 1.18, 95% CI 0.58 to 2.42; 2 RCTs, 184 participants; very low-certainty evidence) or risk of symptomatic CAUTI (RR 0.20, 95% CI 0.01 to 4.06; 1 trial, 94 participants; very low-certainty evidence). None of the included trials investigating prophylactic alpha blockers reported the number of participants with dysuria.

AUTHORS' CONCLUSIONS

There is some evidence to suggest the removal of indwelling urethral catheters late at night rather than early in the morning may reduce the number of people who require recatheterisation. It appears that catheter removal after shorter compared to longer durations probably reduces the risk of symptomatic CAUTI and may reduce the risk of dysuria. However, it may lead to more people requiring recatheterisation. The other evidence relating to the risk of symptomatic CAUTI and dysuria is too uncertain to allow us to draw any conclusions. Due to the low certainty of the majority of the evidence presented here, the results of further research are likely to change our findings and to have a further impact on clinical practice. This systematic review has highlighted the need for a standardised set of core outcomes, which should be measured and reported by all future trials comparing strategies for the removal of short-term urinary catheters. Future trials should also study the effects of short-term indwelling urethral catheter removal on non-surgical patients.

The long-term urinary dysfunction after type C2 radical hysterectomy in patients with cervical cancer

Radical hysterectomy (RH) may cause lower urinary tract symptoms (LUTS) for patients with cervical cancer. Few data are available on the long-term LUTS of these patients and whether the symptoms relate to the route of surgery remain unclear. Here, we assessed the long-term urinary dysfunction in cervical cancer patients after RH based on a self-reported questionnaire. A total of 168 patients after type C2 RH, either by laparoscopy (LRH) or laparotomy (ARH), were analysed. The median length of follow-up was 54 ± 8.35 months. The total incidence of urinary dysfunction was around 40%. Patients with LRH had more intermittent stream and feeling of incomplete emptying than those in ARH group. Our data indicate the irreversible damage of RH to urinary function of cervical cancer patients, who should be informed of the long-term and high incidence of urinary dysfunction after RH when they choose surgical treatment.Impact StatementWhat is already known on this subject? Radical hysterectomy (RH) with pelvic lymphadenectomy is standard surgical care for patients with cervical cancer. RH could induce urinary dysfunction, including bladder sensation loss, hypertonic and hypotonic bladder, urinary incontinence, etc. Studies mainly focus on short- or mid-term urinary dysfunction and stated that spontaneous recovery of urinary function is to be expected within 6-12 months after surgery.What the results of this study add? The lower urinary tract symptoms last for years after type C2 RH, indicating the irreversible damage of RH to urinary function of cervical cancer patients. The incidence of bladder dysfunction is increased in patients submitted to laparoscopic RH compared to abdominal RH.What the implications are of these findings for clinical practice and/or further research? Cervical cancer patients should be informed of the long-term and high incidence of urinary dysfunction after RH when they choose surgical treatment.

Postoperative interventions for preventing bladder dysfunction after radical hysterectomy in women with early-stage cervical cancer

BACKGROUND

Bladder dysfunction is a common complication following radical hysterectomy, caused by the damage to pelvic autonomic nerves that innervate the muscles of the bladder, urethral sphincter, and pelvic floor fasciae. Bladder dysfunction increases the rates of urinary tract infection, hospital visits or admission, and patient dissatisfaction. In addition, bladder dysfunction can also negatively impact patient quality of life (QoL). Several postoperative interventions have been proposed to prevent bladder dysfunction following radical hysterectomy. To our knowledge, there has been no systematic review evaluating the effectiveness and safety of these interventions for preventing bladder dysfunction following radical hysterectomy in women with cervical cancer.

OBJECTIVES

To evaluate the effectiveness and safety of postoperative interventions for preventing bladder dysfunction following radical hysterectomy in women with early-stage cervical cancer (stage IA2 to IIA2).

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 4) in the Cochrane Library, MEDLINE via Ovid (1946 to April week 2, 2020), and Embase via Ovid (1980 to 2020, week 16). We also checked registers of clinical trials, grey literature, conference reports, and citation lists of included studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) evaluating the effectiveness and safety of any type of postoperative interventions for preventing bladder dysfunction following a radical hysterectomy in women with stage IA2 to IIA2 cervical cancer.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected potentially relevant RCTs, extracted data, assessed risk of bias, compared results, and made judgments on the quality and certainty of the evidence. We resolved any disagreements through discussion or consultation with a third review author. Outcomes of interest consisted of spontaneous voiding recovery one week after the operation, quality of life (QoL), adverse events, post-void residual urine volume one month after the operation, urinary tract infection over the one month following the operation, and subjective urinary symptoms.

MAIN RESULTS

We identified 1464 records as a result of the search (excluding duplicates). Of the 20 records that potentially met the review criteria, we included five reports of four studies. Most of the studies had unclear risks of selection and reporting biases. Of the four studies, one compared bethanechol versus placebo and three studies compared suprapubic catheterisation with intermittent self-catheterisation. We identified two ongoing studies. Bethanechol versus placebo The study reported no information on the rate of spontaneous voiding recovery at one week following the operation, QoL, adverse events, urinary tract infection in the first month after surgery, and subjective urinary symptoms for this comparison. The volume of post-void residual urine, assessed at one month after surgery, among women receiving bethanechol was lower than those in the placebo group (mean difference (MD) -37.4 mL, 95% confidence interval (CI) -60.35 to -14.45; one study, 39 participants; very-low certainty evidence). Suprapubic catheterisation versus intermittent self-catheterisation The studies reported no information on the rate of spontaneous voiding recovery at one week and post-void residual urine volume at one month following the operation for this comparison. There was no difference in risks of acute complication (risk ratio (RR) 0.77, 95% CI 0.24 to 2.49; one study, 71 participants; very low certainty evidence) and urinary tract infections during the first month after surgery (RR 0.77, 95% CI 0.53 to 1.13; two studies, 95 participants; very- low certainty evidence) between participants who underwent suprapubic catheterisation and those who underwent intermittent self-catheterisation. Available data were insufficient to calculate the relative measures of the effect of interventions on QoL and subjective urinary symptoms.

AUTHORS' CONCLUSIONS

None of the included studies reported rate of spontaneous voiding recovery one week after surgery, time to a post-void residual volume of urine of 50 mL or less, or post-void residual urine volume at 6 and 12 months after surgery, all of which are important outcomes for assessing postoperative bladder dysfunction. Limited evidence suggested that bethanechol may minimise the risk of bladder dysfunction after radical hysterectomy by lowering post-void residual urine volume. The certainty of this evidence, however, was very low. The effectiveness of different types of postoperative urinary catheterisation (suprapubic and intermittent self-catheterisation) remain unproven.

Catheter-Associated Urinary Tract Infections in Adult Patients

BACKGROUND

Urinary tract infections are among the more common types of nosocomial infection in Germany and are associated with catheters in more than 60% of cases. With increasing rates of antibiotic resistance worldwide, it is essential to distinguish catheter-associated asymptomatic bacteriuria from catheter-associated urinary tract infection (CA-UTI).

METHODS

This review is based on publications from January 2000 to March 2019 that were retrieved by a selective search in Medline. Randomized clinical trials and systematic reviews in which the occurrence of CA-UTI in adult patients was a primary or secondary endpoint were included in the analysis. Two authors of this review, working independently, selected the publications and extracted the data.

RESULTS

508 studies were identified and 69 publications were selected for analysis by the prospectively defined criteria. The studies that were included dealt with the following topics: need for catheterization, duration of catheterization, type of catheter, infection prophylaxis, education programs, and multiple interventions. The duration of catheterization is a determinative risk factor for CA-UTI. The indications for catheterization should be carefully considered in each case, and the catheter should be left in place for the shortest possible time. The available data on antibiotic prophylaxis do not permit any definitive conclusion, but they do show a small benefit from antibiotic-impregnated catheters and from systemic antibiotic prophylaxis.

CONCLUSION

Various measures, including careful consideration of the indication for catheterization, leaving catheters in place for the shortest possible time, and the training of nursing personnel, can effectively lower the incidence of CA-UTI. The eous in some respects, and thus no recommendations can be given on certain questions relevant to CA-UTI.

The effects of bladder training on bladder functions after transurethral resection of prostate

AIM AND OBJECTIVES

The aim of this was to examine the effect of bladder training on bladder functions.

BACKGROUND

Urinary catheterization is frequently performed in order to evaluate the outcomes of the surgical procedures and to monitor the urine output after urology operations.

DESIGN AND METHODS

This quasi-experimental study was conducted in the urology clinic in Istanbul, Turkey in which 50 males were nonrandomly assigned to either a bladder training (n = 28) or a control group (n =22). In the bladder training groups, the urinary catheters of the patients were clamped at 4-hr intervals and then were left open for 5 min on the second postoperative day. This study was created in accordance with TREND Statement Checklist.

RESULTS

The first urgency time and the first voiding time were longer, and the prevoiding and the voiding volumes were higher following the removal of the catheter in the training group (p = 0.001). In addition, the evaluation of the patient bladder diaries in the first three days after the discharge period revealed that the daily frequencies of micturition and nocturia were lower (p = 0.04), the mean duration of intervals between the micturition was longer (p = 0.006), and the mean voided urinary volume was higher (p = 0.024) in the training group.

CONCLUSION

At the end of the study, it is observed that bladder training performed by clamping the catheter on postoperative day 2 after Transurethral Resection of Prostate (TUR-P) operation is a significant positive effect on the storage symptoms of the patients.

RELEVANCE TO CLINICAL PRACTICE

Before removing the urinary catheter, bladder training programme affects positively to patients, especially prevoiding and the voiding volumes, the daily frequencies of micturition and nocturia on postoperative periods.