INCIDENCE OF URINARY TRACTINFECTIONS IN WOMEN WITH POST OPERATIVE VOIDING DYSFUNCTION
B. BROWN1, V. WONG 2,M. I. FRAZER 1;
1Urogynaecology, Gold CoastUniv. Hosp., Southport, QLD, Australia, 2Nepean Med.Campus, Univ. of Sydney, Penrith, Australia.
Introduction: Urogynaecologicalpatients are at increased risk of post-operative voiding dysfunction(POVD) due to their age (often over 50yo), advance pelvic organprolapse, post-operative opioid use and previous pelvic orincontinence surgery1. The risk of POVD is 2-43%2.Clean intermittent self-catheterization (CISC) is the preferredmanagement of short term (1-3 days) POVD, with lower risks ofbacteriuria (14 vs 38%) and urinary tract infection (UTI) (12 vs 33%)than transurethral indwelling catheters (IDC)3. POVDresolves sooner with CISC than IDC (18 h vs 72 h)3. Aretrospective surgical study concluded that the risk of UTI doublesif an IDC remains in-situ for more than 2 days4.Inpatients requiring long-term catheter use it is accepted that CISC orsuprapubic catheters (SPC) are preferable over IDC but evidence tosupport this is lacking5. There is a paucity of data onthe optimal catheter route for women who suffer from medium term (3days - 6 weeks) POVD after urogynaecological surgery.Our currentmanagement of POVD requires a repeat trial of void (TOV) after oneweek. Three successful voids with residuals of less than 150mls arerequired. If patients are unable to pass the TOV they will continuewith or be taught to perform CISC. Patients who are unable to performCISC safely will have an IDC inserted.
Objective: The aimof the current study is to establish if one route of catheter usecarries a higher risk of UTI. Our hypothesis is that IDC isassociated with a higher rate of infection than CISC.
Methods:The study is a retrospective, single centre cohort study. Women whounderwent urogynaecological surgery (prolapse, incontinence or both)between 1 January 2014 and 31 December 2016 were identified via thehospital’s theatre database. Women who developed POVD attended anoutpatient clinic for a TOV - these women were identified using theoutpatient clinic calendar. Patient EMR notes were reviewed todetermine if they were treated for a UTI during the time of catheteruse. Urine culture results were reviewed and positive culturesrecorded if available. Additional information collected include age,BMI, type and date of surgery, TOV in hospital, route of catheterusage at discharge, date trial of void passed and further surgery toaddress voiding dysfunction. For the purpose of this study, patientswere only included if they were using catheters upon discharge fromtheir surgical admission.
Results: Over the periodidentified, 550 women underwent urogynaecological surgeries under thecare of 4 specialists. Median age was 59 (range 27-91). 58 cases ofPOVD were identified. 64% were treated with CISC and 36% had an IDCin situ.
Outcomesof patients with POVD
PassedTOV at first visit
30 patients (51.7%) were treatedfor a UTI - 21 in the CISC group and 9 in the IDC group. 6 of the IDCpatients were treated for the UTI once they started performing CISC.Therefore, 27 of 30 (90%) treated infections occurred in patientsperforming CISC and 3 (10%) in patients with an IDC in situ. 16infections (52%) were confirmed on urine culture. 7 patients (23.3%)were commenced on antibiotics prior to first review inoutpatients.
Conclusions: The rate of infection in patientswith POVD was high, with 51.7% of our patients treated for a UTI. 90%of these infections occurred while patients were performing CISC. Aprospective study is required to further evaluate these findings,including a urine culture on admission (prior to surgery) and upondischarge from hospital. Antibiotic cover for the duration ofcatheter use should be considered. An audit of patient technique inperforming CISC will be beneficial.
References: 1. Int JWomen’s Health 2014;6:829 2. BJOG. 2011;118(9):1055-1060