M Regina Torloni1, Rachel Riera1, Ewelina Rogozińska2,3, Özge Tunçalp4, A Metin Gülmezoglu4, Mariana Widmer4. 1. Department of Medicine, Evidence Based Health Care Post-Graduate Program, São Paulo Federal University, São Paulo, Brazil. 2. Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. 3. Multidisciplinary Evidence Synthesis Hub (MESH), Barts and the London School of Medicine, Queen Mary University London, London, UK. 4. Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
Abstract
BACKGROUND: Bladder catheterization duration after urinary obstetric fistula surgery varies widely. OBJECTIVE: To assess the effect of bladder catheterization duration after urinary obstetric fistula surgery. SEARCH STRATEGY: Medline, EMBASE, CINAHL, GIM, and POPLINE databases were searched, without language restrictions, using "obstetric urinary fistula" and "catheterization" from inception to September 30, 2017. SELECTION CRITERIA: Randomized controlled trials comparing shorter versus longer (>10 days) bladder catheterization after urinary obstetric fistula repair were included. DATA COLLECTION AND ANALYSIS: Data were extracted and meta-analyses were conducted. The GRADE system was used to assess evidence quality. MAIN RESULTS: Two unblinded non-inferiority trials (684 patients combined) were included. There were no differences between shorter and longer bladder catheterization in the risk of fistula repair breakdown either before (relative risk [RR] 1.14; 95% confidence interval [CI] 0.49-2.64) or after (RR 1.64; 95% CI 0.81-3.31) hospital discharge. Similarly, urinary infection (RR 5.18; 95% CI 0.25-107.44); urinary incontinence before (RR 1.15; 95% CI 0.54-2.43) or after (RR 1.16; 95% CI 0.62-2.18) discharge; urinary retention (RR 1.34; 95% CI 0.79-2.27); or extended hospital stay (RR 9.33; 95% CI 0.51-172.41) were not associated with duration of catheterization. Evidence quality was low or moderate. CONCLUSIONS: Shorter, compared to longer, bladder catheterization duration after urinary obstetric fistula surgery was not associated with significant outcome differences.
BACKGROUND: Bladder catheterization duration after urinary obstetric fistula surgery varies widely. OBJECTIVE: To assess the effect of bladder catheterization duration after urinary obstetric fistula surgery. SEARCH STRATEGY: Medline, EMBASE, CINAHL, GIM, and POPLINE databases were searched, without language restrictions, using "obstetric urinary fistula" and "catheterization" from inception to September 30, 2017. SELECTION CRITERIA: Randomized controlled trials comparing shorter versus longer (>10 days) bladder catheterization after urinary obstetric fistula repair were included. DATA COLLECTION AND ANALYSIS: Data were extracted and meta-analyses were conducted. The GRADE system was used to assess evidence quality. MAIN RESULTS: Two unblinded non-inferiority trials (684 patients combined) were included. There were no differences between shorter and longer bladder catheterization in the risk of fistula repair breakdown either before (relative risk [RR] 1.14; 95% confidence interval [CI] 0.49-2.64) or after (RR 1.64; 95% CI 0.81-3.31) hospital discharge. Similarly, urinary infection (RR 5.18; 95% CI 0.25-107.44); urinary incontinence before (RR 1.15; 95% CI 0.54-2.43) or after (RR 1.16; 95% CI 0.62-2.18) discharge; urinary retention (RR 1.34; 95% CI 0.79-2.27); or extended hospital stay (RR 9.33; 95% CI 0.51-172.41) were not associated with duration of catheterization. Evidence quality was low or moderate. CONCLUSIONS: Shorter, compared to longer, bladder catheterization duration after urinary obstetric fistula surgery was not associated with significant outcome differences.