Intermittent vs continuous catheterization for postpartum urinary retention: A multicenter randomized controlled trial

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

doi:10.1016/j.ajogmf.2023.101084

Intermittent vs continuous catheterization for postpartum urinary retention: A multicenter randomized controlled trial

Am J Obstet Gynecol MFM. 2023 Oct;5(10):101084. doi: 10.1016/j.ajogmf.2023.101084. Epub 2023 Jul 8.

Authors

Gal Bachar¹, Yoav Siegler², Eli Kabakov², Roy Lauterbach², Naphtali Justman², Emilie Ben-Ezry³, Eran Weiner³, Yael Ganor-Paz³, Enav Yefet⁴, Thana Khamaisi⁵, Zohar Nachum⁶, Manal Massalha⁶, Khadeje Shamali⁷, Nizar Khatib², Yaniv Zipori², Zeev Weiner⁸, Dana Vitner²

Affiliations

¹ Department 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). Electronic address: gal.bachar13@gmail.com.
² Department 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).
³ Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel (Dr Ben-Ezry, Dr Weiner, and Dr Ganor-Paz).
⁴ Department of Obstetrics and Gynecology, Baruch Padeh Medical Center, Poriya, Israel (Dr Yefet); Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel (Dr Yefet and Dr Khamaisi).
⁵ Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel (Dr Yefet and Dr Khamaisi).
⁶ Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Dr Nachum, Dr Massalha, and Dr Weiner); Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel (Dr Nachum, Dr Massalha, and Dr Shamali).
⁷ Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel (Dr Nachum, Dr Massalha, and Dr Shamali).
⁸ Department 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); Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Dr Nachum, Dr Massalha, and Dr Weiner).

PMID: 37423430
DOI: 10.1016/j.ajogmf.2023.101084

Abstract

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.

Keywords: catheterization; indwelling; intermittent; postpartum urinary retention; pregnancy.