Best evidence summary of early removal of urinary catheter after gastrointestinal surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHU Yulan ¹ , LIAO Min ² , LUO Yu ² , LI Zhiyu ² ,  LI Ka ³

1. West China School of Nursing, Sichuan University / Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. West China School of Nursing, Sichuan University / West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

LI Ka, Email: likalika127127@163.com

Keywords：

gastrointestinal surgery; early removal of urinary catheter; evidence summary

DOI：

10.7507/1007-9424.202411006

Video：

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Objective To screen the current optimal evidence for early removal of urinary catheters in patients after gastrointestinal surgery both domestically and internationally. Methods We systematically searched the following databases or website, including the UpToDate, the British Medical Journal Best Practice, the Jonna Briggs Institute Evidence-Based Healthcare Center, the Guidelines International Network, the National Institute for Health and Clinical Excellence Guidelines, the Registered Nurses’ Association of Ontario, the Scottish Intercollegiate Guidelines Network, the European Association of Urology Nurses, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, ClinicalKey, Embase, PubMed, Web of Science, CNKI, Wanfang, and VIP. The literature was evaluated, and the evidence was extracted and summarized. Results A total of 27 articles were included, including 3 clinical decisions, 4 guidelines, 18 systematic reviews, 1 practice recommendation, and 1 expert consensus. The 23 evidence items were classified into five categories: pre-catheterization assessment (6 items), institutional and personnel requirements (2 items), strategies to shorten catheter indwelling time (8 items), bladder recovery strategies (5 items), and timing of catheter removal (2 items). These items were classified 5 evidence levels ccording to the 2014 JBI Evidence-Based Healthcare System Evidence Pre-Grading and Recommendation Level System: level 1 (6 items), level 2 (8 items), level 3 (1 item), level 4 (0 items), and level 5 (8 items). Recommendation grades: grade A (strong recommendation, 14 items) and grade B (weak recommendation, 9 items). Conclusions The high-quality evidence identified in this study regarding early urinary catheter removal can be effectively applied in the clinical management of patients after gastrointestinal surgery. However, there are few studies on this in China. These best evidence should be adaptively implemented according to the specific situation after gastrointestinal surgery in China.

Citation： ZHU Yulan, LIAO Min, LUO Yu, LI Zhiyu, LI Ka. Best evidence summary of early removal of urinary catheter after gastrointestinal surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(4): 468-475. doi: 10.7507/1007-9424.202411006 Copy

1.	Hiraki M, Tanaka T, Sadashima E, et al. Retrospective risk analysis for acute urinary dysfunction after laparoscopic rectal cancer surgery in patients receiving epidural analgesia. Int J Colorectal Dis, 2021, 36(1): 169-175.
2.	Kim HO, Cho YS, Kim H, et al. Scoring systems used to predict bladder dysfunction after laparoscopic rectal cancer surgery. World J Surg, 2016, 40(12): 3044-3051.
3.	Huang L, Yin Y, Liao Y, et al. Risk factors for postoperative urinary retention in patients undergoing colorectal surgery: a systematic review and meta-analysis. Int J Colorectal Dis, 2022, 37(12): 2409-2420.
4.	Saint S, Trautner BW, Fowler KE, et al. A multicenter study of patient-reported infectious and noninfectious complications associated with indwelling urethral catheters. JAMA Intern Med, 2018, 178(8): 1078-1085.
5.	Gould CV, Umscheid CA, Agarwal RK, et al. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol, 2010, 31(4): 319-326.
6.	Ito M, Kobayashi A, Fujita S, et al. Urinary dysfunction after rectal cancer surgery: Results from a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for clinical stage Ⅱ or Ⅲ lower rectal cancer (Japan Clinical Oncology Group Study, JCOG0212). Eur J Surg Oncol, 2018, 44(4): 463-468.
7.	Ghuman A, Dawidek MT, Athwal MS, et al. Prophylactic tamsulosin and urinary retention rates following elective colorectal surgery: a retrospective cohort study. Int J Colorectal Dis, 2022, 37(1): 209-214.
8.	陈佩云, 李子慧, 黄厚强, 等. 腹腔镜下胆囊切除术后腹泻非药物管理的最佳证据总结. 中国普外基础与临床杂志, 2020, 27(9): 1121-1127.
9.	Brouwers MC, Kho ME, Browman GP, et al. AGREE Ⅱ: advancing guideline development, reporting and evaluation in health care. CMAJ, 2010, 182(18): E839-E842. doi: 10.1503/cmaj.090449.
10.	Aromataris E, Fernandez R, Godfrey CM, et al. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc, 2015, 13(3): 132-140.
11.	The Joanna Briggs Institute (JBI). (2017-07-15)[2018-08-29]. http//joannabriggs. org/research/critical-appraisal-tools. html.
12.	Foster MJ, Shurtz S. Making the Critical Appraisal for Summaries of Evidence (CASE) for evidence-based medicine (EBM): critical appraisal of summaries of evidence. J Med Libr Assoc, 2013, 101(3): 192-198.
13.	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版). 护士进修杂志, 2015, 30(11): 964-967.
14.	Catheter associated urinary tract infection. Elsevier. 2023. https://www.clinicalkey.com/#!/content/clinical_overview/67-s2.0-ece3cc0c-7449-45d1-b93e-a6b78facb8ff#synopsis-heading-1.
15.	Schaeffer AJ. Complications of urinary bladder catheters and preventive strategies. https://www.uptodate.cn/contents/complications-of-urinary-bladder-catheters-and-preventive-strategies, 2023-06-26/2024-09.
16.	Schaeffer AJ. Placement and management of urinary catheters in adults. https://www.uptodate.cn/contents/placement-and-management-of-urinary-catheters-in-adults, 2024-07-19/2024-09.
17.	Hooton TM, Bradley SF, Cardenas DD, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America. Clin Infect Dis, 2010, 50(5): 625-663.
18.	Geng V, Lurvink H, Pearce I, et al. Indwelling catheterisation in adults—Urethral and suprapubic. https://nurses.uroweb.org/guideline/indwelling-catheterisation-in-adults-urethral-and-suprapubic, 2024.
19.	Patel PK, Advani SD, Kofman AD, et al. Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol, 2023, 44(8): 1209-1231.
20.	Cao M, Wu X, Xu J. A systematic review and meta-analysis of neostigmine for urinary retention after surgeries. Transl Androl Urol, 2022, 11(2): 190-201.
21.	Chen Q, Li N, Wu Y. Neostigmine for postoperative surgical urine retention: A systematic review and meta-analysis. Adv Clin Exp Med, 2024, 33(5): 435-444.
22.	Ellahi A, Stewart F, Kidd EA, et al. Strategies for the removal of short-term indwelling urethral catheters in adults. Cochrane Database Syst Rev, 2021, 6(6): CD004011. doi: 10.1002/14651858.CD004011.
23.	Gao B, Zhang D, Wang Y, et al. The effect of tamsulosin in postoperative urinary retention: a meta-analysis of randomized controlled trials. Naunyn Schmiedebergs Arch Pharmacol, 2023, 396(3): 441-451.
24.	Ghuman A, de Jonge SW, Dryden SD, et al. Prophylactic use of alpha-1 adrenergic blocking agents for prevention of postoperative urinary retention: A review & meta-analysis of randomized clinical trials. Am J Surg, 2018, 215(5): 973-979.
25.	Huang KY, Liang S, Du HG, et al. Transcutaneous electrical acupoint stimulation for prevention of postoperative urinary retention: A systematic review. Heliyon, 2023, 10(1): e23537.
26.	Jackson J, Davies P, Leggett N, et al. Systematic review of interventions for the prevention and treatment of postoperative urinary retention. BJS Open, 2018, 3(1): 11-23.
27.	Liu CF, Chien LW. Moxibustion for managing postoperative urinary retention after hemorrhoidectomy and anorectal surgeries: A systematic review and meta-analysis of randomized controlled trials. J Perianesth Nurs, 2023, 38(6): 881-891.
28.	Makary J, Phan K, McClintock G, et al. Bladder infusion versus standard catheter removal for trial of void: a systematic review and meta-analysis. World J Urol, 2021, 39(6): 1781-1788.
29.	McIntosh S, Hunter R, Scrimgeour D, et al. Timing of urinary catheter removal after colorectal surgery with pelvic dissection: A systematic review and meta-analysis. Ann Med Surg (Lond), 2021, 73: 103148. doi: 10.1016/j.amsu.2021.103148.
30.	Meddings J, Rogers MA, Macy M, et al. Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis, 2010, 51(5): 550-560.
31.	Moola S, Konno R. A systematic review of the management of short-term indwelling urethral catheters to prevent urinary tract infections. JBI Libr Syst Rev, 2010, 8(17): 695-729.
32.	Niël-Weise BS, van den Broek PJ. Urinary catheter policies for short-term bladder drainage in adults. Cochrane Database Syst Rev, 2005(3): CD004203. doi: 10.1002/14651858.CD004203.
33.	Nollen JM, Pijnappel L, Schoones JW, et al. Impact of early postoperative indwelling urinary catheter removal: A systematic review. J Clin Nurs, 2023, 32(9-10): 2155-2177.
34.	Wang LH, Tsai MF, Han CS, et al. Is bladder training by clamping before removal necessary for short-term indwelling urinary catheter inpatient? A systematic review and meta-analysis. Asian Nurs Res (Korean Soc Nurs Sci), 2016, 10(3): 173-181.
35.	Zhong Y, Zeng F, Li J, et al. Electroacupuncture for postoperative urinary retention: A systematic review and meta-analysis. Evid Based Complement Alternat Med, 2018, 2018: 7612618. doi: 10.1155/2018/7612618.
36.	Zhou Z, Gan W, Li Z, et al. Can prophylactic tamsulosin reduce the risk of urinary retention after surgery? A systematic review and meta-analysis of randomized control trials. Int J Surg, 2023, 109(3): 438-448.
37.	Joanna Briggs Institute. Removal of short-term indwelling urethral catheters. Nurs Stand, 2008, 22(22): 42-45.
38.	Meddings J, Skolarus TA, Fowler KE, et al. Michigan Appropriate Perioperative (MAP) criteria for urinary catheter use in common general and orthopaedic surgeries: results obtained using the RAND/UCLA Appropriateness Method. BMJ Qual Saf, 2019, 28(1): 56-66.
39.	Liu JY, Hu QL, Lamaina M, et al. Surgical technical evidence review for acute cholecystectomy conducted for the AHRQ safety program for improving surgical care and recovery. J Am Coll Surg, 2020, 230(3): 340-354.
40.	Bentvelsen RG, Bruijning ML, Chavannes NH, et al. Reducing inappropriate urinary catheter use by involving patients through the participatient app: before-and-after study. JMIR Form Res, 2022, 6(4): e28983. doi: 10.2196/28983.
41.	Bagley K, Severud L. Preventing catheter-associated urinary tract infections with incontinence management alternatives: PureWick and Condom Catheter. Nurs Clin North Am, 2021, 56(3): 413-425.
42.	Saint S, Krein SL, Fowler KE, et al. Condom catheters versus indwelling urethral catheters in men: A prospective, observational study. J Hosp Med, 2019, 14: E1-E4. doi: 10.12788/jhm.3180.
43.	Møller T, Engedal MS, Plum LM, et al. Reduced need for urinary bladder catheterization in the postanesthesia care unit after implementation of an evidence-based protocol: A prospective cohort comparison study. Eur Urol Open Sci, 2021, 26: 27-34.
44.	Han CS, Kim S, Radadia KD, et al. Comparison of urinary tract infection rates associated with transurethral catheterization, suprapubic tube and clean intermittent catheterization in the postoperative setting: A network meta-analysis. J Urol, 2017, 198(6): 1353-1358.
45.	Grass F, Slieker J, Frauche P, et al. Postoperative urinary retention in colorectal surgery within an enhanced recovery pathway. J Surg Res, 2017, 207: 70-76.
46.	Griffiths RD, Fernandez RS, Murie P. Removal of short-term indwelling urethral catheters: the evidence. J Wound Ostomy Continence Nurs, 2004, 31(5): 299-308.

1. Hiraki M, Tanaka T, Sadashima E, et al. Retrospective risk analysis for acute urinary dysfunction after laparoscopic rectal cancer surgery in patients receiving epidural analgesia. Int J Colorectal Dis, 2021, 36(1): 169-175.
2. Kim HO, Cho YS, Kim H, et al. Scoring systems used to predict bladder dysfunction after laparoscopic rectal cancer surgery. World J Surg, 2016, 40(12): 3044-3051.
3. Huang L, Yin Y, Liao Y, et al. Risk factors for postoperative urinary retention in patients undergoing colorectal surgery: a systematic review and meta-analysis. Int J Colorectal Dis, 2022, 37(12): 2409-2420.
4. Saint S, Trautner BW, Fowler KE, et al. A multicenter study of patient-reported infectious and noninfectious complications associated with indwelling urethral catheters. JAMA Intern Med, 2018, 178(8): 1078-1085.
5. Gould CV, Umscheid CA, Agarwal RK, et al. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol, 2010, 31(4): 319-326.
6. Ito M, Kobayashi A, Fujita S, et al. Urinary dysfunction after rectal cancer surgery: Results from a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for clinical stage Ⅱ or Ⅲ lower rectal cancer (Japan Clinical Oncology Group Study, JCOG0212). Eur J Surg Oncol, 2018, 44(4): 463-468.
7. Ghuman A, Dawidek MT, Athwal MS, et al. Prophylactic tamsulosin and urinary retention rates following elective colorectal surgery: a retrospective cohort study. Int J Colorectal Dis, 2022, 37(1): 209-214.
8. 陈佩云, 李子慧, 黄厚强, 等. 腹腔镜下胆囊切除术后腹泻非药物管理的最佳证据总结. 中国普外基础与临床杂志, 2020, 27(9): 1121-1127.
9. Brouwers MC, Kho ME, Browman GP, et al. AGREE Ⅱ: advancing guideline development, reporting and evaluation in health care. CMAJ, 2010, 182(18): E839-E842. doi: 10.1503/cmaj.090449.
10. Aromataris E, Fernandez R, Godfrey CM, et al. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc, 2015, 13(3): 132-140.
11. The Joanna Briggs Institute (JBI). (2017-07-15)[2018-08-29]. http//joannabriggs. org/research/critical-appraisal-tools. html.
12. Foster MJ, Shurtz S. Making the Critical Appraisal for Summaries of Evidence (CASE) for evidence-based medicine (EBM): critical appraisal of summaries of evidence. J Med Libr Assoc, 2013, 101(3): 192-198.
13. 王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版). 护士进修杂志, 2015, 30(11): 964-967.
14. Catheter associated urinary tract infection. Elsevier. 2023. https://www.clinicalkey.com/#!/content/clinical_overview/67-s2.0-ece3cc0c-7449-45d1-b93e-a6b78facb8ff#synopsis-heading-1.
15. Schaeffer AJ. Complications of urinary bladder catheters and preventive strategies. https://www.uptodate.cn/contents/complications-of-urinary-bladder-catheters-and-preventive-strategies, 2023-06-26/2024-09.
16. Schaeffer AJ. Placement and management of urinary catheters in adults. https://www.uptodate.cn/contents/placement-and-management-of-urinary-catheters-in-adults, 2024-07-19/2024-09.
17. Hooton TM, Bradley SF, Cardenas DD, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America. Clin Infect Dis, 2010, 50(5): 625-663.
18. Geng V, Lurvink H, Pearce I, et al. Indwelling catheterisation in adults—Urethral and suprapubic. https://nurses.uroweb.org/guideline/indwelling-catheterisation-in-adults-urethral-and-suprapubic, 2024.
19. Patel PK, Advani SD, Kofman AD, et al. Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol, 2023, 44(8): 1209-1231.
20. Cao M, Wu X, Xu J. A systematic review and meta-analysis of neostigmine for urinary retention after surgeries. Transl Androl Urol, 2022, 11(2): 190-201.
21. Chen Q, Li N, Wu Y. Neostigmine for postoperative surgical urine retention: A systematic review and meta-analysis. Adv Clin Exp Med, 2024, 33(5): 435-444.
22. Ellahi A, Stewart F, Kidd EA, et al. Strategies for the removal of short-term indwelling urethral catheters in adults. Cochrane Database Syst Rev, 2021, 6(6): CD004011. doi: 10.1002/14651858.CD004011.
23. Gao B, Zhang D, Wang Y, et al. The effect of tamsulosin in postoperative urinary retention: a meta-analysis of randomized controlled trials. Naunyn Schmiedebergs Arch Pharmacol, 2023, 396(3): 441-451.
24. Ghuman A, de Jonge SW, Dryden SD, et al. Prophylactic use of alpha-1 adrenergic blocking agents for prevention of postoperative urinary retention: A review & meta-analysis of randomized clinical trials. Am J Surg, 2018, 215(5): 973-979.
25. Huang KY, Liang S, Du HG, et al. Transcutaneous electrical acupoint stimulation for prevention of postoperative urinary retention: A systematic review. Heliyon, 2023, 10(1): e23537.
26. Jackson J, Davies P, Leggett N, et al. Systematic review of interventions for the prevention and treatment of postoperative urinary retention. BJS Open, 2018, 3(1): 11-23.
27. Liu CF, Chien LW. Moxibustion for managing postoperative urinary retention after hemorrhoidectomy and anorectal surgeries: A systematic review and meta-analysis of randomized controlled trials. J Perianesth Nurs, 2023, 38(6): 881-891.
28. Makary J, Phan K, McClintock G, et al. Bladder infusion versus standard catheter removal for trial of void: a systematic review and meta-analysis. World J Urol, 2021, 39(6): 1781-1788.
29. McIntosh S, Hunter R, Scrimgeour D, et al. Timing of urinary catheter removal after colorectal surgery with pelvic dissection: A systematic review and meta-analysis. Ann Med Surg (Lond), 2021, 73: 103148. doi: 10.1016/j.amsu.2021.103148.
30. Meddings J, Rogers MA, Macy M, et al. Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis, 2010, 51(5): 550-560.
31. Moola S, Konno R. A systematic review of the management of short-term indwelling urethral catheters to prevent urinary tract infections. JBI Libr Syst Rev, 2010, 8(17): 695-729.
32. Niël-Weise BS, van den Broek PJ. Urinary catheter policies for short-term bladder drainage in adults. Cochrane Database Syst Rev, 2005(3): CD004203. doi: 10.1002/14651858.CD004203.
33. Nollen JM, Pijnappel L, Schoones JW, et al. Impact of early postoperative indwelling urinary catheter removal: A systematic review. J Clin Nurs, 2023, 32(9-10): 2155-2177.
34. Wang LH, Tsai MF, Han CS, et al. Is bladder training by clamping before removal necessary for short-term indwelling urinary catheter inpatient? A systematic review and meta-analysis. Asian Nurs Res (Korean Soc Nurs Sci), 2016, 10(3): 173-181.
35. Zhong Y, Zeng F, Li J, et al. Electroacupuncture for postoperative urinary retention: A systematic review and meta-analysis. Evid Based Complement Alternat Med, 2018, 2018: 7612618. doi: 10.1155/2018/7612618.
36. Zhou Z, Gan W, Li Z, et al. Can prophylactic tamsulosin reduce the risk of urinary retention after surgery? A systematic review and meta-analysis of randomized control trials. Int J Surg, 2023, 109(3): 438-448.
37. Joanna Briggs Institute. Removal of short-term indwelling urethral catheters. Nurs Stand, 2008, 22(22): 42-45.
38. Meddings J, Skolarus TA, Fowler KE, et al. Michigan Appropriate Perioperative (MAP) criteria for urinary catheter use in common general and orthopaedic surgeries: results obtained using the RAND/UCLA Appropriateness Method. BMJ Qual Saf, 2019, 28(1): 56-66.
39. Liu JY, Hu QL, Lamaina M, et al. Surgical technical evidence review for acute cholecystectomy conducted for the AHRQ safety program for improving surgical care and recovery. J Am Coll Surg, 2020, 230(3): 340-354.
40. Bentvelsen RG, Bruijning ML, Chavannes NH, et al. Reducing inappropriate urinary catheter use by involving patients through the participatient app: before-and-after study. JMIR Form Res, 2022, 6(4): e28983. doi: 10.2196/28983.
41. Bagley K, Severud L. Preventing catheter-associated urinary tract infections with incontinence management alternatives: PureWick and Condom Catheter. Nurs Clin North Am, 2021, 56(3): 413-425.
42. Saint S, Krein SL, Fowler KE, et al. Condom catheters versus indwelling urethral catheters in men: A prospective, observational study. J Hosp Med, 2019, 14: E1-E4. doi: 10.12788/jhm.3180.
43. Møller T, Engedal MS, Plum LM, et al. Reduced need for urinary bladder catheterization in the postanesthesia care unit after implementation of an evidence-based protocol: A prospective cohort comparison study. Eur Urol Open Sci, 2021, 26: 27-34.
44. Han CS, Kim S, Radadia KD, et al. Comparison of urinary tract infection rates associated with transurethral catheterization, suprapubic tube and clean intermittent catheterization in the postoperative setting: A network meta-analysis. J Urol, 2017, 198(6): 1353-1358.
45. Grass F, Slieker J, Frauche P, et al. Postoperative urinary retention in colorectal surgery within an enhanced recovery pathway. J Surg Res, 2017, 207: 70-76.
46. Griffiths RD, Fernandez RS, Murie P. Removal of short-term indwelling urethral catheters: the evidence. J Wound Ostomy Continence Nurs, 2004, 31(5): 299-308.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Best evidence summary of early removal of urinary catheter after gastrointestinal surgery

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