Effects of clean intermittent catheterization and transurethral indwelling catheterization on the management of urinary retention after gynecological surgery: a systematic review and meta-analysis

BACKGROUND: Urinary retention is a common complication after gynecological surgery. Clean intermittent catheterization has been reported to have a lower incidence of urinary tract infections compared to transurethral indwelling catheterization. This study conducted a systematic review of randomized controlled trials (RCTs) to compare the effects of these two catheterization techniques after gynecological surgery. METHODS: We searched PubMed, EMBASE, Web of Science, Cochrane, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Chinese Scientific Journal Database (VIP) for 227 articles comparing the effects of the above two catheterization methods on urinary tract infections and urethral function after gynecological surgery up to November 2022. Subsequently, the Cochrane tool for assessing the risk of bias was employed to assess the quality of the included literature. Meta-analysis was performed using Stata software, and the appropriate models were adopted to pool the effect sizes. RESULTS: A total of 19 articles involving 1,823 patients were included. The results showed that clean intermittent catheterization could greatly minimize the risk of urinary tract infections [relative risk (RR) =0.24, 95% confidence interval (CI): 0.20 to 0.28], improve the recovery of bladder function (RR =1.51, 95% CI: 1.32 to 1.72), reduce residual urine volume (mL) [weighted mean difference (WMD) = −82.64, 95% CI: −108.32 to −56.96], and shorten the duration of catheter maintenance (days) (WMD =−3.14, 95% CI: −4.98 to −1.30) compared with indwelling catheterization. Subgroup and regression analyses revealed that clean intermittent catheterization could achieve a more favorable therapeutic effect in patients receiving cervical cancer surgeries than those receiving other conventional gynecological procedures. CONCLUSIONS: Clean intermittent catheterization can lower the incidence of urinary tract infections, reduce residual urine volume, shorten the duration of catheter maintenance, and improve bladder function recovery. Thus, it may be more effective in patients undergoing radical cervical cancer resection.