Urinary Effects of Routine Urethral Catheterisation during Elective Caesarean Section in Enugu, Nigeria: A Randomised Controlled StudyCorrespondence Address :
Dr. Joseph Tochukwu Enebe,
Consultant, Department of Obstetrics and Gynaecology, Enugu State University
of Science and Technology College of Medicine/Teaching Hospital, Parklane,
Introduction: Routine urinary catheterisation during elective caesarean section is a common practice. However, this practice involves some urinary bladder morbidities.
Aim: To determine the effect of non-catheterisation of the urinary bladder on the incidence of significant bacteriuria and other perioperative urinary bladder morbidities during elective caesarean section in Enugu, Nigeria.
Materials and Methods: A multicentre, non-inferiority randomised controlled study was conducted. The study centres were the University of Nigeria Teaching Hospital (UNTH), Mother of Christ Specialist Hospital (MOCSH), and Blessed Assurance Specialist Hospital (BASH), all in Enugu State, Southeast Nigeria. A total of 264 eligible consenting term pregnant women who had a caesarean section in these three specialist centres in Enugu, Nigeria over a one-year period were recruited and they completed the study and their results were analysed. Study group (A) did not receive urethral catheterisation while the control group (B) had urethral catheterisation on the operating table and the catheters were removed 24 hours after the surgery. Clean catched urine samples were collected from each participant 72 hours after the surgery for urine microscopy and culture. The primary outcome measure was the incidence of significant bacteriuria 72 hours postoperatively while the secondary outcome measures included incidence of intraoperative bladder injury (accidental cystostomy), primary postpartum haemorrhage and urinary retention.
Results: Nine (6.8%) women in the non-catheter group (n=132) had significant bacteriuria as against 17 (12.9%) women in the catheter group (n=132), (Relative Risk (RR)=0.5 (95% CI: 0.24-1.14) p-value=0.098). Urinary retention was observed in 10.6% (14/132) of the non-catheter group while there was no case of urinary retention in the control group (p<0.001). There was neither a case of accidental cystostomy nor postpartum haemorrhage in either group.
Conclusion: Non-catheterisation of the urinary bladder during elective caesarean section had no significant relationship with the incidence of significant bacteriuria in Enugu, Nigeria. Rather, it was associated with postoperative urinary retention when compared to women who had a urinary catheter
Non-catheterisation, Significant bacteriuria, Urinary retention
Date of Submission: Aug 08, 2020
Date of Peer Review: Sep 21, 2020
Date of Acceptance: Dec 21, 2020
Date of Publishing: Mar 01, 2021
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 08, 2020
• Manual Googling: Dec 08, 2020
• iThenticate Software: Jan 23, 2021 (13%)
ETYMOLOGY: Author Origin
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)