A meta-analysis comparing suprapubic and transurethral catheterization for bladder drainage after abdominal surgery

Background: Although bladder drainage is widely used for general surgical patients undergoing laparotomy, there is little consensus on whether suprapubic or transurethral catheterization is better. Method: A systematic database search was undertaken to find all studies of suprapubic catheterization. Randomized controlled trials were identified for inclusion. Endpoints for analysis were bacteriuria, patient satisfaction and recatheterization rates. A meta-analysis was performed using fixed-effect or random-effect models as appropriate, depending on heterogeneity. Results: After abdominal surgery, transurethral catheterization is associated with significant bacteriuria (relative risk (RR) = 2.02, P < 0.001, 95 per cent confidence interval (c.i.) 1.34 to 3.04) and pain or discomfort (RR = 2.94, P = 0.004, 95 per cent c.i. 1.41 to 6.14). Recatheterization rates using the transurethral method were not increased significantly (RR = 1.97, P = 0.213, 95 per cent c.i. 0.68 to 5.74) with heterogeneity between studies. Conclusion: The suprapubic route for bladder drainage in general surgery is more acceptable to patients and reduces microbiological morbidity.