Duration of transurethral indwelling catheter ( TIC ) following vaginal prolapse surgery

The optimal duration of transurethral indwelling catheter (TIC) following vaginal prolapse surgery has been investigated by the following randomized clinical trials. All the studies consistently favour placement of a transurethral catheter for short term use, thus this will consequently conclude a shorter hospital stay. Duration of transurethral indwelling catheter (TIC) following vaginal prolapse surgery

Vol. 34, No. 1, 2012   Duration of transurethral indwelling catheter following vaginal prolapse surgery Our routine clinical practice suggests that prolonged catheterization, presence of a vaginal pack as well as the use of regional/general anaesthesia are certainly important factors that limit patient mobilization, hence lengthen hospital stay following vaginal prolapse surgery.Optimal duration of TIC following pelvic floor surgery has long been a debate.
A survey of the Dutch Urogynaecological Society members 1 showed 75.4% of catheters are left for more than 24 hours (mean duration was 3.7 days) after anterior repair.However, majority of vaginal packs were removed on the first postoperative day.
The optimal duration of transurethral indwelling catheter (TIC) following vaginal prolapse surgery has been investigated by the following randomized clinical trials.All the studies consistently favour placement of a transurethral catheter for short term use, thus this will consequently conclude a shorter hospital stay.In an interesting study of fast track vaginal prolapse surgery 4 indicated that the proportion of urinary retention (defined as volume > 450 ml in their study), was only 12.2%, with a median hospital stay of 24 hrs.There was high patient satisfaction and acceptability rates with only 3 out of 40 discharged after 48 hrs.Recently, Hakvoort RA et al 5 showed that out of 1037 patients undergoing vaginal prolapse surgery, only 147 (14%) experienced abnormal post void residuals.In addition, patients preferred clean intermittent catheterisation (CIC) instead of TIC in the event of abnormal post-void residuals.

Sri Lanka Journal of Obstetrics and Gynaecology K Sivanesan
There is emerging evidence that vaginal prolapse surgery under local anaesthesia with or without sedation is feasible.Even procedures such as vaginal para-vaginal repairs and vaginal uterosacral ligament suspensions have been carried out under local anaesthesia with high patient satisfaction rates 6,7 .Duration of the surgery does not seem to be a limiting factor.Recently, Hill N et al described their experience of local anaesthesia with conscious sedation with ramifentanyl in relation to pelvic floor repairs 8 .Authors were able to discharge 95% of patients six hours post-surgery without any complications.This clearly offers huge financial savings and lowers the demand for in-patient beds.
Considering the above, one should perhaps challenge our traditional ways of anaesthesia and post-operative management of vaginal surgery and should contemplate the removal of vaginal packs and catheters a few hours after surgery.If voiding difficulties are encountered, it could be managed with CIC.Careful selection of patients in addition to training of CIC prior to surgery would be of added value.In most instances, CIC could be taught by the nursing staff on the day of admission.A randomised controlled trial may be the way forward to answer the unanswered questions.
3t al 2 compared immediate versus 24 hr catheter removal after an anterior repair.There was no increased rate of re-catheterization and an immediate catheter removal was associated with shorter hospital stay.A similar RCT by Glavind K et al3compared the removal of pack and catheter in situ for 3 hrs and comparatively 24 hrs.Neither increased the risk of bleeding nor the need for re-operation.