NEW YORK (Reuters Health) – Placement of an indwelling catheter in the bladder before cesarean section is a long-standing practice that is “not justified by research evidence,” clinicians from China report in the obstetrics journal BJOG.

Not doing so, they found, leads to fewer urinary tract infections (UTIs) without an increase in urinary retention or intraoperative difficulties.

Dr. Y. Li of the Chinese Evidence-Based Medicine Centre in Chengdu and colleagues searched the medical literature for studies comparing use versus nonuse of indwelling urinary catheters in cesarean section.

They found three relevant studies involving a total of 1,084 subjects. Two were randomized controlled trials (RCTs) and one was a nonrandomized controlled trial (NRCT)

Based on these studies, they conclude that it is not necessary, and can be harmful, to routinely place an indwelling urinary catheter prior to cesarean section in hemodynamically stable women, although “better and larger” randomized trials are needed to confirm this, they emphasize.

Two studies they reviewed (one RCT and one NRCT) contained data on the rate of UTIs with and without use of urinary catheters. In both studies, not placing one was associated with a lower incidence of UTIs; the relative risk was 0.08 in the RCT and 0.10 in the NRCT.

All three trials contained data on the rate of urinary retention, and the pooled results showed no significant difference in the rate of urinary retention between catheterized and catheterized women, the authors report.

Avoiding postoperative urinary retention is “one major rationale for catheterizing the urinary bladder,” they note, but not doing so during cesarean section does not appear to increase the rate of urinary retention, based on the studies they reviewed.

They also note, however, that roughly 4.5% of women who did not have a urinary catheter placed during cesarean section needed one after surgery. In one study, 23 women in the uncatheterized group had a urinary catheter placed at the end of surgery to prevent uterine atony and postoperative urinary retention. “This was a preventative step taken by the surgeon,” they note.

Of the women who needed postoperative urinary catheterization in another study, four had emergency cesarean delivery, “suggesting that there may be a correlation between emergency cesarean delivery and the need for a bladder catheter.”

In the one study reporting rates of intraoperative difficulties during cesarean section, rates were low with or without urinary catheters and did not differ between groups (1.4% and 1.4%; RR 1.00).

Not placing a urinary catheter during cesarean section was also associated with a lower rate of discomfort at first voiding, less time until first void and ambulation, shorter length of hospital stay and lower health care costs.

The researchers say there are several limitations to their analysis and they emphasize that large RCTs with rigorous methodology and appropriate outcome measures are needed to confirm and extend their observations.

Reference:
Is routine indwelling catheterisation of the bladder for caesarean section necessary? A systematic review
BJOG, Published online December 23, 2010.