Suprapubic Versus Transurethral Catheterization: Perioperative Outcomes After Colpocleisis

Transient postoperative urinary retention occurs in approximately half of women after colpocleisis; however, the optimal strategy for postoperative catheter management is unclear. This study compared length of catheterization and postoperative complications after colpocleisis between planned suprapubic catheter placement and transurethral catheterization.

This is a retrospective cohort study including all women undergoing colpocleisis from January 2015 to December 2019 in a large female pelvic medicine and reconstructive surgery practice. Women undergoing planned placement of a suprapubic catheter intraoperatively during colpocleisis and women who were discharged with a transurethral catheter after failing an active voiding trial postoperatively after colpocleisis were included. Women with surgical complications requiring prolonged catheterization and those needing catheterization before surgery were excluded. Length of catheterization and postoperative complications were compared between groups.

Two hundred fifty-eight women underwent colpocleisis during the study time frame and 170 were eligible for analysis: with 78 in the planned suprapubic catheter group and 92 in the transurethral catheter group. Length of catheterization with suprapubic catheter placement was significantly longer than transurethral catheter placement with median catheter days of 11 (95% confidence interval [CI], 10-14) versus 7 (95% CI, 6-7), which persisted after adjustment (HR, 2.61, 95% CI, 1.85-3.68, P < 0.001). No significant differences were found in overall complications or urinary tract infections.

Suprapubic catheter placement at the time of colpocleisis is associated with increased length of catheterization postoperatively compared with transurethral catheter for management of postoperative urinary retention. These data can aid surgeons in preoperative counseling and shared decision making with patients.