NEW YORK (Reuters Health) – The common practice of placing a urinary catheter during laparoscopic inguinal hernia repair to protect against postoperative urinary retention (PUR) may not be worthwhile, a new study suggests.
Dr. Aldo Fafaj and colleagues from the Cleveland Clinic enrolled 491 patients undergoing laparoscopic inguinal hernia repair at six institutions, randomly assigning them to urinary catheter placement or no catheter placement.
As reported in JAMA Surgery, the median age was 61; nearly 95% were male. The median body mass index was 26.1, and 85 patients had benign prostatic hypertrophy (BPH). Most patients had unilateral hernias (37.1%, right side; 23.6%, left side). A scrotal component was present in 58 individuals (11.8%).
An extraperitoneal approach was used in 71.7%; 28.3% of repairs were done via a transabdominal preperitoneal approach. The median operative time was 73, with all surgeries done under general anesthesia.
The only difference between the catheter and no-catheter groups was a higher volume of crystalloids infused intraoperatively in the catheter group (1100 mL vs 1000 mL; P<0.001).
Five patients (two in the no-catheter group, three in the catheter group) were lost to follow up. Of the remaining 486 patients, 44 (9.1%) developed PUR. There was no difference in the PUR rate between the catheter and no-catheter groups (23 patients [9.6%] vs 21 patients [8.5%], respectively, P=0.79). There were no intraoperative bladder injuries in either group.
There was no difference in the timing of PUR diagnosis and treatment between the two groups. PUR was diagnosed before hospital discharge in 61.4% of cases. Most cases were treated with an indwelling catheter, with same day discharge.
There were four unplanned reoperations in the no-catheter group: two for hematoma evacuation, one to repair a port-site hernia, and one for small bowel obstruction. In the catheter group, one patient presented with PUR to an emergency department, where attempts to place a urinary catheter were unsuccessful and a suprapubic catheter was ultimately required.
On multivariate analysis, factors associated with developing PUR were intraoperative anticholinergic medications (odds ratio 3.53; P=0.04), presence of BPH (OR, 3.44; P<0.001), age older than 65 (OR, 1.05; P=0.005), and lower volume of crystalloids infused intraoperatively (OR, 0.90; P=0.03).
“The lack of apparent immediate clinical benefit accompanied by the potential for rare but devastating complications offer a compelling argument in favor of abandoning routine use of catheters during laparoscopic inguinal hernia repair in patients who void urine preop,” the authors conclude.
In an editorial, Dr. Martin Almquist of Skane University Hospital in Sweden commends the authors for undertaking a randomized trial to investigate the value of a routine procedure. He agrees that not even a simple procedure such as placing a urinary catheter is without risk and that the study provides a strong argument for abandoning routine catheter placement during inguinal hernia repair.
He adds, “Further reductions in the rate of PUR may perhaps be achieved by using enhanced recovery protocols.”
SOURCE: https://bit.ly/3nqGPAD and https://bit.ly/39ZhI4H JAMA Surgery, online June 15, 2022.
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