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Intermittent vs continuous catheterization for postpartum urinary retention: A multicenter randomized controlled
Gal Bachar1, Yoav Siegler1, Eli Kabakov1
1Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Dr Bachar, Dr Siegler, Dr Kabakov, Dr Lauterbach, Dr Justman, Dr Khatib, Dr Zipori, Dr Weiner, and Dr Vitner).
Background:
Postpartum urinary retention is a common complication in the immediate postpartum period. However, there is no consensus regarding optimal management.
Objective:
This study aimed to compare 2 catheterization strategies for the treatment of postpartum urinary retention.
Study Design:
A multicenter prospective randomized controlled trial was conducted at 4 university-affiliated medical centers between January 2020 and June 2022. Individuals with postpartum urinary retention (bladder volume of >150 mL) up to 6 hours after vaginal or cesarean delivery were randomly allocated to 1 of 2 protocols: intermittent catheterization every 6 hours, up to 4 times, or continuous catheterization with an indwelling urinary catheter for 24 hours. If postpartum urinary retention was not resolved after 24 hours, an indwelling catheter was inserted for an additional 24 hours in both groups. The primary endpoint was the mean time to postpartum urinary retention resolution. The secondary endpoints included postcatheter urinary tract infection rate and length of hospital stay. The satisfaction rate was estimated using the 30-Item Birth Satisfaction Scale questionnaire.
Results:
After randomization, 73 individuals were allocated to the intermittent catheterization group, and 74 individuals were allocated to the continuous catheterization group. The mean time to postpartum urinary retention resolution was significantly shorter in the intermittent catheterization group than in the continuous catheterization group (10.2±11.8 vs 26.5±9.0 hours; P<.001), with 75% and 93% resolution rates after 1 and 2 catheterizations, respectively. The number of individuals who achieved resolution at 24 hours was 72 (99%) in the intermittent catheterization group and 67 (91%) in the continuous catheterization group (P=.043). The satisfaction rate was higher in all categories in the intermittent catheterization group than in the continuous catheterization group (P<.001). No intercohort difference was found in the urinary tract infection rates (P=.89) or hospital stay length (P=.58).
Conclusion:
Compared with indwelling catheterization, intermittent catheterization for urinary retention after delivery was associated with quicker postpartum urinary retention resolution and a higher satisfaction rate without increasing the complication rates.
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