Midnight removal: an improved approach to removal of catheters. Removal of catheter at midnight versus early morning: the patients' perspective. Removal of urinary catheters: midnight vs 0600 hours. Randomised study of the effect of midnight versus 0600 removal of urinary catheters. Does evening removal of urinary catheters shorten hospital stay among general hospital patients? A randomized controlled trial. A comparison of midnight versus early morning removal of urinary catheters after transurethral resection of the prostate. Early removal advances discharge home. Comparison of midnight and early morning catheter removal following prostatectomy. Is an indwelling catheter necessary for bladder drainage after modified Burch colposuspension? How long should urinary bladder catheterisation be continued after vaginal prolapse surgery? A randomised controlled trial comparing short term versus long term catheterisation after vaginal prolapse surgery. Management of postoperative urinary retention: a randomized trial of in-out versus overnight catheterization. Comparison of 1 and 3 days' transurethral Foley catheterization after retropubic incontinence surgery. Early catheter removal following transurethral prostatectomy--impact on length of hospital stay. Bladder management after total joint arthroplasty. Could the incidence of postoperative urinary tract infection be reduced by reversing the sequence of vaginal cleansing and urethral catheterization? Are in-dwelling catheters necessary for 24 hours after hysterectomy? A randomized trial comparing bladder infusion with standard catheter removal after transurethral resection of the prostate. Trial without catheter following acute retention of urine. Efficacy of antimicrobial-impregnated external ventricular drain catheters: a prospective, randomized, controlled trial. Systematic removal of catheter 48 hours following transurethral resection and 24 hours following transurethral incision of prostate: a prospective randomized analysis of 213 patients. Silver alloy coated catheters reduce catheter-associated bacteriuria. A prospective, randomized trial comparing continuous bladder drainage with catheterization at abdominal hysterectomy. [Method for transurethral catheterization for 1-3 days for pelvic floor relaxation in the postoperative period].
There is no recognised policy regarding the timing of urethral catheter removal, although early morning removal is commonly practised. Removing the catheter at midnight allows patients to return to a normal voiding pattern more rapidly and to leave hospital earlier. With an increasing role of the patient as a partner in making a combined decision in care plan goals, it is important to identify the patient's perspective of the experience of removal of catheter (ROC).
                A non-consecutive prospective randomized study was performed in 84 patients who underwent a transurethral resection of the prostate to determine the impact of midnight versus early-morning ROC on sleep deprivation, over all discomfort to the patient.
                There was no difference in the patient experience in both groups. We found a reduced frequency during the first 6 h of ROC at midnight. However, there was an increased incidence of sleep disturbances in this group. This may in part be due to an anxiety of urge incontinence and may be allayed by appropriate counselling. There was no delay in discharge of the patients in both groups.
                The patients must, therefore, be given the choice of ROC either at midnight or early morning, as the advantages of a reduced frequency must be correlated with an increased incidence of sleep disturbances.
                2005 S. Karger AG, Basel In the fields of both nursing and medicine there is a dearth of published literature on the optimum time to remove indwelling urinary catheters (IDCs) following urological surgery. Tradition seems to be in favour of removing IDCs at 0600 hours despite a lack of evidence to support this practice. This study was undertaken to determine whether midnight removal of IDCs resulted in patients' resuming normal voiding patterns. A prospective clinical trial was conducted to determine the impact midnight removal of urinary catheters would have on the patients' voiding pattern, and subsequent discharge from hospital. One hundred and sixty patients were entered into the study. The patients were allocated at random to have their urinary catheter removed either at midnight or at 0600 hours. Patients who had their catheters removed at midnight passed a greater volume of urine with both their first (268 ml compared with 177 ml; P<0.0001) and second voids (322 ml compared with 195 ml; P<0.0001) than their counterparts in the 0600 group. This permitted earlier discharge from hospital. The results reported in this study support the findings of earlier research that midnight removal of IDC leads to an earlier resumption of normal voiding patterns, permits earlier discharge from hospital and appears to reduce patients' anxiety. The recommendation from this study is that there should be a change in hospital policy so that the majority of IDCs are removed at midnight. A randomised controlled trial was undertaken to determine the effects of midnight removal of urinary catheters on patients' voiding patterns and subsequent discharge from hospital. Patients whose urinary catheters were removed at midnight showed a greater volume of initial void than those whose catheters were removed at the usual time of 0600. Removal of urinary catheters routinely at midnight permits earlier assessment of patients' voiding, which may allow for earlier discharge from hospital. Literature indicates that removing urinary catheters at midnight facilitates earlier discharge among urology patients, but the effect of evening removal on the general patient population is unknown. The objective of this study was to investigate whether removing a urinary catheter at 22.00 hours compared to 06.00 hours among a general hospital population would lead to earlier hospital discharge.
                Randomized controlled trial.
                The study was conducted in a large tertiary hospital in Brisbane, Australia. Two hundred and ten general surgical and medical patients who had an indwelling catheter as part of their routine care were included.
                Length of hospital stay after catheter removal was not significantly affected by the timing of its removal among general hospital patients: mean hours morning 186.1; mean evening 209.3, (P = .309). In a cohort of surgical patients, the hospital stay was shorter in the evening removal group (mean hours morning 186.1; mean evening 209.3), but this result was not statistically significant (P = .127). Patients in the evening group were more likely to have a longer time period between catheter removal and the first postcatheter void, mean hours morning, 3.76 vs evening, 4.89 (t = -2.59, CI - 1.99 to -0.27). Timing of removal of the urinary catheter had no effect on the volume of the first void, mean volume morning, 214.7 mL vs evening, 221.4 mL. Twenty-five (12.1%) patients were recatheterized, but the rate of recatheterization between groups was similar. There were no differences in postdischarge problems between groups.
                Among general hospital patients, removing an indwelling urinary catheter at 22:00 hours does not shorten the length of stay and is effective in increasing the time to first void. This article describes a study that compares the outcomes of midnight versus early morning urethral catheter removal after transurethral resection of the prostate. SUBJECTS AND SETTING/METHODS: The research setting was a large, metropolitan hospital in Sydney, Australia. Forty-eight patients who had undergone transurethral resection of the prostate were randomly assigned to either group A, catheter removal at 2400 hours (n = 20), or group B, catheter removal at 0600 hours (n = 28).
                Data collected included time to first void, volume of first void, time between catheter removal and discharge from hospital, weight of prostatic resection, and tissue pathology.
                There was no significant difference between the 2 groups with respect to pathology, weight of prostatic resection, mean volume of first void, or time to first void after catheter removal. There was a significant difference in the time between catheter removal and discharge from hospital. Eighty-five percent of those having catheters removed at 2400 hours were discharged on the same day as catheter removal, as compared with 65% of those who underwent catheter removal at 0600 hours (chi 2 = 12.684; P < 0.005).
                After transurethral resection of the prostate, removal of the urethral catheter at 2400 hours reduced the length of hospital stay, but did not significantly affect the time to first void or the volume of the first void. Resumption of normal voiding is necessary before prostatectomy patients can be discharged from hospital. This study assesses the effect upon this of the timing of catheter removal. Catheterization is considered to be a mandatory procedure for adequate bladder drainage following an anti-incontinence operation until the recovery of normal voiding function occurs. We conducted this prospective study to challenge this practice. A total of 86 patients with genuine stress incontinence who underwent a modified Burch coplosuspension were randomized into two groups based on the day of operation. The study group consisted of 42 patients who had the transurethral Foley catheter removed postoperatively the next morning (Group A). The control group was composed of 43 patients who had the transurethral indwelling catheter left in place until the fifth postoperative day (Group B). The percentages of immediate voiding difficulties in Groups A and B were 7.1% and 0%, respectively ( P>0.05). The postoperative urinary tract infection rates of Groups A and B were 16.6% and 23.3%, respectively ( P>0.05). The success rates of our patients were not compromised after our modified operative procedures (78.6% with dry results and 19.0% with improved symptoms in Group A vs. 74.4% with dry results and 20.9% with improved symptoms in Group B, P >0.05). Our results imply that it is not necessary that an indwelling catheter, for bladder drainage, be left in place until the fifth postoperative day to prevent immediate voiding difficulties. To determine whether prolonged urinary bladder catheterisation after vaginal prolapse surgery is advantageous.
                Randomised controlled trial.
                A large training hospital in the Netherlands.
                Patients undergoing anterior colporrhaphy.
                One hundred patients were included. Patients were randomised into two groups. In one group (n= 50), a transurethral catheter was in place for four days post-operatively and removed on the fifth post-operative day. In the other group (n= 50), catheterisation was not prolonged and the catheter was removed the morning after surgery. Residual volumes after removal of the catheter were measured by ultrasound scanning. Where residual volumes of >200 mL were found the patient was recatheterised for three more days. Urinary cultures were taken before removal of the catheter. Six patients were excluded: four in the standard prolonged catheterisation group and two in the not prolonged catheterisation group.
                Need for recatheterisation, urinary tract infection, mean duration of catheterisation and hospital stay.
                Residual volumes exceeding 200 mL and need for recatheterisation occurred in 9% in the standard prolonged catheterisation group versus 40% of patients in the not prolonged catheterisation group (OR 0.15, 95% CI 0.045-0.47). Positive urine cultures were found in 40% of cases in the standard prolonged catheterisation group compared with 4% in the not prolonged catheterisation group (OR 15, 95% CI 3.2-68.6). Mean duration of catheterisation was 5.3 days in the standard prolonged catheterisation group and 2.3 days in the not prolonged catheterisation group (P < 0.001). Mean duration of hospitalisation was 7 days in the standard prolonged catheterisation group and 5.7 days in the not prolonged group (P < 0.001).
                The disadvantages of prolonged catheterisation outweigh the advantages, therefore, removal of the catheter on the morning after surgery may be preferable and longer term catheterisation should only be undertaken where there are specific indications. There has been no consensus on the best catheterization strategy for the management of postoperative urinary retention. A prospective randomized trial was undertaken to establish the best practice guidelines for the management of postoperative urinary retention. The authors also evaluated the contemporary incidence of urinary retention following different categories of general surgery and examined risk factors associated with its occurrence.
                All patients who underwent elective inpatient surgery between January 2002 and June 2003 were recruited into the study. Patients who developed postoperative urinary retention were randomized to either having in-out catheterization or placement of an indwelling catheter for 24 h after surgery.
                A total of 1448 patients was recruited. The overall incidence of urinary retention was 4.1% (n = 60). Significant risk factors associated with postoperative urinary retention included old age, anorectal procedures and use of spinal anaesthesia. Comparison of re-catheterization and urinary tract infection rates between patients who were treated with in-out versus overnight catheterization found no significant differences.
                Postoperative urinary retention should be managed by in-out catheterization. Indwelling catheterization for 24 h appeared to bestow no additional benefits. The incidence of urinary retention increases with age, anorectal procedures and the use of spinal anaesthesia. This prospective study was done to see if reducing transurethral Foley catheterization from 3 days to 1 would lead to fewer urinary tract infections without an increase in voiding problems. Ninety-one women undergoing retropubic surgery for stress urinary incontinence (Burch or Marshall-Marchetti-Krantz) were randomized to either 1 or 3 days' catheterization. Antibiotics were not used. Infection was diagnosed in 9 (20.0%) patients in the 1-day group and in 16 (34.8%) in the 3-day group. Delayed voiding occurred in 13 (28.9%) and 10 (21.7%) patients, respectively, and 5 (11.1%) and 3 (6.5%), respectively, received a new catheter. The differences do not reach statistical significance. Therefore, catheter time may safely be reduced to 1 day. This may lead to fewer infections but also somewhat more voiding problems. If a transurethral catheter is to be used, on balance the two regimens are equivalent. To investigate whether early catheter removal following transurethral prostatectomy (TURP) is safe and whether it has any effect on the length of hospital stay.
                Following transurethral prostatectomy 59 patients were randomized into one of two groups: those whose catheter was removed on day 1 after surgery and those whose catheter was removed on day 2. The incidence of complications and the duration of post-operative hospital stay were assessed.
                Catheter removal on day 1 led to a significantly shorter post-operative hospital stay (2.3 days versus 3.3 days) and did not incur a higher incidence of complications.
                Removal of the catheter on the first day following TURP is safe in selected patients and leads to a shorter post-operative hospital stay. This study was undertaken to determine the impact of an indwelling Foley catheter on bladder dysfunction and incidence of urinary tract infections after total joint arthroplasty. A prospective randomized controlled trial was conducted assigning use of an indwelling Foley catheter (group 1) or intermittent catheterization (group 2) for 48 hours following operation. Postoperative cultures were obtained on days 2 and 5, and the number of intermittent catheterization events and void and catheterization volumes were recorded. Concurrent cost-effectiveness analysis was conducted. One hundred nineteen of 174 consecutive patients having elective primary total joint arthroplasty completed the study. Five of 62 patients (8%) in group 1 and 7 of 57 patients (12%) in group 2 developed urinary tract infections (NS, P = 45). Twenty patients (35%) in group 2 and 12 (19%) in group 1 required straight catheterization for inability to void 48 hours after surgery (P = .05). Seventeen patients (35%) in group 2 and eight patients (16%) in group 1 required straight catheterization after epidural analgesia was discontinued (P = .024). Bladder management by indwelling Foley catheter saved more than 150 minutes of direct nursing contact per patient and $3,000 in total hospital costs. Indwelling Foley catheters reduced the frequency of postoperative urinary retention, were less labor intensive than intermittent straight catheterization, and were not associated with an increased risk of urinary infection. In the setting of epidural anesthesia and postoperative analgesia for total joint arthroplasty, management by indwelling catheter is a cost-effective strategy to facilitate postoperative return of normal bladder function. Postoperative urinary tract infection (UTI) is a common hospital infection after gynaecological operations. A prospective randomized study was performed to examine whether the incidence of UTI could be reduced by reversing the sequence of vaginal cleansing and urethral catheterization. Subjects were randomly allocated to: (1) urethral catheterization before vaginal cleansing; and (2) urethral catheterization after vaginal cleansing. Urine cultures were performed immediately after the procedures as the baseline, on the day of catheter removal, and two days after catheter removal. Patients were examined daily after the operation for any urinary symptoms and fever. The incidences of preoperative asymptomatic bacteriuria were similar in both groups, seven of 84 in group 1 vs. eight of 83 in group 2. Among those with negative urine culture before the operation, 77 in group 1 and 75 in group 2, there was no significant difference in postoperative bacteriuria at catheter removal (23 vs. 22) and two days later (35 vs. 42). No significant difference was noted in the incidence of UTI (5 vs. 10, P = 0.25), with a trend towards less UTI in group 1. Voiding discomfort was more common, and fever less common in group 1. There were significant associations between urine culture results at three different occasions. Bacteriuria at catheter removal is associated with a 7.2 times risk of bacteriuria two days later, 2.4 times risk of urinary symptoms and 3.2 times risk of UTI. Routine surveillance at catheter removal is not cost-effective. We conclude that postoperative bacteriuria and UTI are common. Reversing the sequence of the procedures cannot reduce the incidence. There is no evidence to change the status quo. In-dwelling catheters for 24 hours after operation are used routinely in gynecologic surgery. This study assesses whether the immediate removal of an in-dwelling catheter after the operation affects the rate of recatheterization, febrile morbidity, symptomatic urinary tract infections, or subjective pain assessments.
                This study was a prospective randomized controlled trial comprised of 250 women who underwent hysterectomy and who did not require bladder suspension or strict fluid treatment. The in-dwelling catheter was removed either immediately after the operation or on the first day after the operation. The association between clinical variables and the length of catheterization were assessed by chi-squared analysis.
                Patients were assigned randomly into 2 groups, with no significant differences in the outcomes, only in the perception of pain. Clinical events included fever (>/=38.5 degrees C) that occurred in 6 patients in the in-dwelling catheter group compared with 5 patients in the early removal group (P=.01), symptomatic urinary tract infections in 3 patients in both groups (P=.99), and recatheterization in 3 patients in the in-dwelling catheter group compared with 5 patients in the early removal group (P=.17). Subjectively, patients in the early removal group reported significantly less pain than did the in-dwelling group (P<.001).
                The early removal of in-dwelling catheters after operation was not associated with an increased rate of febrile events, urinary tract infections, or need for recatheterization. In addition, subjective pain assessment was significantly less in the early removal group. Early removal of an in-dwelling catheter immediately after operation is not associated with adverse events. To examine the effect of bladder infusion before catheter removal on patients' readiness for discharge and the day of discharge after transurethral resection of the prostate (TURP).
                The study comprised 75 consecutive patients undergoing TURP who were randomized to either have their catheter removed in the standard manner (38 patients), or to undergo bladder infusion before a trial of voiding (ToV) on the second day after TURP (37 patients).
                In those undergoing bladder infusion, seven (19%) patients were discharged on the same day as their ToV, compared with five (13%) in the standard group. Of the 75 patients, 15 (68%) were discharged by the third day after TURP whether or not the bladder had been filled. In the infusion group, 23 (62%) were ready for discharge on the same day as their TOV, compared with only 14 (37%) in the standard group (P < 0.05).
                Bladder infusion before a ToV after TURP significantly increases the rate of readiness for discharge, allowing an early decision to discharge on the second day in a large proportion of patients. A total of 60 patients with acute urinary retention were studied to establish whether a trial without a catheter was justified and to identify subgroups of patients most likely to benefit from this practice. The patients were randomly allocated to 3 groups; the catheters were removed either immediately after the bladder was emptied, or 24 or 48 h later; 17 patients urinated satisfactorily after removal of the catheter. Re-establishment of micturition was not associated with the length of history or severity of symptoms of prostatism, with age or the presence of urinary tract infection. The mean retained volume of urine in patients with a satisfactory result was 786 ml and 1069 ml in the failures. Of the 34 patients with retained volumes of less than 900 ml, 15 were successful in re-establishing micturition compared with 2 of 26 of those with retained volumes greater than 900 ml. The time of catheter removal was not important. The 17 successful patients were reviewed 6 months later. None reported further urinary retention; 6 had required prostatectomy for severe symptoms, 6 had minor symptoms and 5 were symptomless. It was concluded that a trial without a catheter is worthwhile, since 11 of 60 patients had not required surgery, but it should be avoided in patients with a residual volume exceeding 900 ml. Catheter-related infection of the cerebrospinal fluid (CSF) pathways is a potentially life-threatening complication of external ventricular drainage. A major source of infection is bacterial contamination along the external ventricular drain (EVD) catheter track. The authors examined the efficacy of EVD catheters impregnated with minocycline and rifampin in preventing these catheter-related infections.
                The authors conducted a prospective, randomized clinical trial at six academic medical centers. All hospitalized patients 18 years or older who required placement of an EVD catheter were eligible for inclusion in the study. Patients were randomly assigned to undergo placement of an EVD with a catheter impregnated with minocycline and rifampin or a standard untreated catheter (control group). To assess primary outcome, CSF samples were collected using a sterile technique at the time of catheter insertion, at least every 72 hours while the catheter remained in place, and at the time of catheter removal. At the time of removal, CSF cultures were obtained from the tip and tunneled segments of each catheter by performing semiquantitative roll-plate and quantitative sonication techniques. Of the 306 patients enrolled in the study, data from 288 were included in the final analysis. Eighteen patients were excluded from analysis: 14 because the ventricular catheter was in place less than 24 hours, and four because CSF cultures obtained at the time of catheter insertion were positive for infection. Of these 288 patients, 139 were assigned to the control group and 149 to the treatment group. The two groups were well matched with respect to all clinical characteristics, including patient sex and mean age, indication for catheter placement, and length of time the catheter remained in place. The antibiotic-impregnated catheters were one half as likely to become colonized as the control catheters (17.9 compared with 36.7%, respectively, p < 0.0012). Positive CSF cultures were seven times less frequent in patients with antibiotic-impregnated catheters compared with those in the control group (1.3 compared with 9.4%, respectively, p = 0.002).
                The use of EVD catheters impregnated with minocycline and rifampin can significantly reduce the risk of catheter-related infections. The interval before removal of the catheter used in prostatic transurethral surgery depends to a great extent on the surgeon, with a frequently empirical orientation. We conducted a prospective, randomized and controlled study of 213 patients who underwent transurethral surgery for benign prostatic hyperplasia. The catheter was removed systematically 24 hours after transurethral incision and 48 hours after transurethral resection of the prostate (group 1-52 and 54 patients, respectively) or the catheterization interval was determined by each surgeon in accordance with the usual criteria (group 2-52 and 55 patients, respectively). No statistically significant differences were noted between these 2 groups in regard to complications. We conclude that systematic removal of the catheter at the aforementioned periods is cost-effective, safe and comfortable for the patient. The tendency of indwelling catheters to cause urinary tract infection was evaluated in a randomised clinical study of 223 patients. A Foley catheter coated with silver alloy on both inner and outer surfaces was used in 60 patients; 60 others received a Teflonised latex Foley's catheter and the remaining 103 patients were excluded because of antibiotic treatment, diabetes, etc. There was a statistically significant difference in the incidence of catheter-associated bacteriuria (greater than 10(5) organisms/ml) in the 2 groups after 6 days' catheterisation: 6 patients with the silver coated catheter developed bacteriuria compared with 22 who had the Teflonised latex catheter. This suggests that the silver impregnated urethral catheters reduce the incidence of catheter-associated urinary tract infection. To compare the infection rate and post-operative morbidity between in-dwelling urinary catheterization and 'in-out' catheterization at the time of routine total abdominal hysterectomy.
                The study comprised 100 patients who were blindly randomized to have either an indwelling Foley catheter or an 'in-out' catheterization at the time of surgery. Follow-up data on the retention of urine, urinary symptoms and infection were obtained.
                Of the 95 patients with complete data, 36% of those undergoing in-out catheterization had urinary retention after operation, requiring bladder emptying, compared with 4% of those receiving an indwelling catheter (P < 0.001). In addition, 29% of the catheterized group had urinary tract bacteriuria compared with 13% of the uncatheterized group (P < 0.025).
                This randomized controlled trial showed that in-out urinary catheterization at the time of routine abdominal hysterectomy was associated with a significantly higher incidence of post-operative urinary retention compared with in-dwelling catheterization, and may have implications for long-term bladder function. This clinic trial, randomized and blinded was done to determine efficient whether reducing transurethral Foley catheterization from 3 days to 1 would lead to fewer urinary (UTI) tract infections without retention becoming a problem. Fifty women undergoing vaginal plastic repair to either 1 or 3 days catheterization. Of 25 patients catheterized for both group postoperative urinary retention occurred in 2 (8%) and required a new catheter. Of 25 patients catheterized for 1 day UTI was diagnosed in 1 (4%) and in 5(20) of those catheterized for 3 days, mean postoperative stay was 2 day for patients catheterized for 1 day and 3 days for those for 3 days. The differences are statistically significant, therefore catheter time may safely be reduced to 1 day. This may be associated with a reduced rate postoperative urinary retention, urinary tract infection, and stay postoperative.
There is suggestive but inconclusive evidence of a benefit from midnight removal of the indwelling urethral catheter. There are resource implications but the magnitude of these is not clear from the trials. The evidence also suggests shorter hospital stay after early rather than delayed catheter removal but the effects on other outcomes are unclear. There is little evidence on which to judge other aspects of management, such as catheter clamping.