Postpartum urinary retention (PUR) is a common complication in the immediate postpartum period. Yet, there is no consensus regarding optimal management.
To compare between two catheterization strategies for the treatment of PUR.
A multi-center prospective randomized controlled trial was conducted at four university-affiliated medical centers between January 2020 and June 2022. Individuals with PUR (bladder volume>150 mL) up to 6 hours following vaginal or Cesarean delivery were randomly allocated to one of two protocols: intermittent catheterization (IC) every 6 h, up to 4 times, or continuous catheterization (CC) with an indwelling urinary catheter for 24 h. If PUR was not resolved after 24 hours, an indwelling catheter was inserted for an additional 24 h in both groups. The primary endpoint was the mean time to PUR resolution. The secondary endpoints included post-catheter urinary tract infection rate and length of hospital stay. Satisfaction rate was estimated using the Birth Satisfaction Scale (BSS-30) questionnaire.
Following randomization, 73 individuals were allocated to the IC group and 74 to the CC group. Mean time to PUR resolution was significantly shorter in the IC compared with the CC group (10.2±11.8 h vs. 26.5±9.0 h, p<0.001), with 75% and 93% resolution rates after one and two catheterizations, respectively. The number of individuals who achieved resolution at 24 h was 72 (99%) and 67 (91%) in the IC and CC groups, respectively (p=0.043). The satisfaction rate was higher in all categories in the IC compared with the CC group (p<0.001). No intercohort differences were found in the urinary tract infection rates (p=0.89) or hospital stay length (p=0.58).
Intermittent catheterization for urinary retention following delivery is associated with quicker PUR resolution and a higher satisfaction rate, compared with indwelling catheterization, without increasing complication rates.
American journal of obstetrics & gynecology MFM. 2023 Jul 08 [Epub ahead of print]
Gal Bachar, Yoav Siegler, Eli Kabakov, Roy Lauterbach, Naphtali Justman, Emilie Ben-Ezry, Eran Weiner, Yael Ganor-Paz, Enav Yefet, Thana Khamaisi, Zohar Nachum, Manal Massalha, Khadeje Shamali, Nizar Khatib, Yaniv Zipori, Zeev Weiner, Dana Vitner
Department of Obstetrics & Gynecology, Rambam Health Care Campus, Haifa, Israel. Electronic address: ., Department of Obstetrics & Gynecology, Rambam Health Care Campus, Haifa, Israel., Department of Obstetrics & Gynecology, Wolfson medical center, Holon Israel., Department of Obstetrics & Gynecology, Baruch Padeh Medical center, Poriya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel., Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel., Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Department of Obstetrics & Gynecology, Emek Medical Center, Afula, Israel., Department of Obstetrics & Gynecology, Emek Medical Center, Afula, Israel., Department of Obstetrics & Gynecology, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.