Intermittent outdoes continuous catheterization for postpartum urinary retention

In women with postpartum urinary retention (PUR; bladder volume ≥150 mL) up to 6 hours following vaginal or Caesarean delivery, intermittent catheterization led to quicker time to PUR resolution and was associated with a higher satisfaction rate than continuous catheterization, with no additional complications, a study from Israel reports.

“Mean time to resolution in the intermittent catheterization arm was 10.2 hours, whereas with continuous catheterization, it was 26.5 hours,” said Dr Dana Vitner from the Rambam Health Care Campus, Haifa, Israel, at SMFM 2023. A comparison between arms yielded a statistically significant difference (p<0.001).

Using the Birth Satisfaction Scale-30, mean satisfaction rates were significantly higher in the intermittent vs the continuous catheterization arm, Vitner added. The parameters evaluated were quality of care (36.9 vs 31.1; p<0.001), women’s attributes (34 vs 30; p<0.001), and stress experienced (56.1 vs 50.1; p<0.001).

Vitner and colleagues arrived at these results after evaluating 147 women with PUR up to 6 hours following vaginal delivery or after catheter removal following Caesarean delivery. The investigators prospectively evaluated the participants to determine the most effective catheterization strategy to resolve overt* PUR. The women were randomized 1:1 to either intermittent catheterization every 6 hours (up to four times) or continuous catheterization with an indwelling urinary catheter for 24 hours until full resolution. Full resolution was defined as post-void residual volume <150 mL estimated by either catheter or transabdominal ultrasound. [SMFM 2023, abstract 81]

An indwelling catheter was inserted for an additional 24 hours for any participant with PUR that persisted beyond 24 hours. Initial urine volume at diagnosis was around 900 mL in both arms.

In the intermittent catheterization arm, 75 percent of women achieved resolution within a single catheterization.

By hour 24, all but one patient in the intermittent catheterization arm achieved PUR resolution. With continuous catheterization, only 91 percent (67 out of the 74 women randomized to this group) had full resolution. “The difference between arms was statistically significant,” said Vitner. The comparison between arms yielded a p-value of 0.043.

Moreover, all women in the intermittent catheterization arm achieved full resolution by 48 hours, whereas with continuous catheterization, the 100-percent resolution rate was only achieved at hour 72.

There were no differences between the intermittent and the continuous catheterization arms in terms of duration of hospital stay (median 3.7 vs 3.6 days; p=0.58) and positive urine culture (29 percent vs 30 percent; p=0.89).

PUR can lead to urinary tract infections, can prolong hospital stay, and may reduce patient satisfaction. Apart from these short-term adverse outcomes, women may also suffer from functional urinary bladder damage, need for self-catheterizations, and impairment in quality of life in the long term, noted Vitner.

While there is no standard protocol for catheterization, the findings highlight the advantage of intermittent catheterization over the continuous strategy in providing PUR resolution.