Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: A Prospective Randomized Trial to Compare Immediate and 24-hours Delayed Catheter Removal Following Total Abdominal Hysterectomy
Brief Summary: Total abdominal hysterectomy is a common gynaecological operation performed worldwide. In Hong Kong, it was the most common gynaecological open procedure done and the number of hysterectomies performed increased by almost 50% in 2004 when compared to 1999. In-dwelling catheter use after uncomplicated abdominal hysterectomy has been the standard method for bladder treatment after the operation. It is traditionally advocated to assess urinary output and to prevent post-operative urinary retention as patients with abdominal wound are unable to increase the intra-abdominal pressure to aid voiding. However, in-dwelling catheters have been associated with increased white cell counts and higher rates of positive urine cultures, and subsequently urinary tract infection can lead to increased morbidity, duration of hospital stay, and overall healthcare cost.

Duration of catheter use post-operatively is generally based on custom rather than evidence-based knowledge and therefore varies considerably. The current practice of the investigators hospital is to leave an in-dwelling catheter in-situ for 24 hours after an uncomplicated open gynaecological surgery. Schiotz et al showed that twenty-four-hour catheterization after common gynaecological procedures was associated with a low rate of voiding problems after catheter removal. Post-operative urinary retention leading to bladder atony may increase the long-term morbidity through increased risk of infection, detrusor instability and voiding difficulties. In-dwelling catheter in the immediate post-operative period will help to combat this problem. However, this has to be balanced against the potential risk of catheter-associated urinary tract infection which varies from 5% to 43% in the published trials.

A prospective randomized study comparing immediate versus delayed catheter removal following hysterectomy showed that delayed removal after operation was not associated with an increased rate of febrile events or urinary tract infections, but a significantly higher subjective pain assessment. The size of the catheter used was 16F which was not the standard 12F that the investigators used in the investigators hospital setting. It is postulated that if a smaller caliber in-dwelling catheter is used, it will not result in an increased subjective pain assessment, and the catheter can be left in-situ for 24 hours without causing increased adverse outcomes but possibly reducing recatheterisation rate post-operatively.


Options:
A: Arm Label: removal of catheter; Type: OTHER; Interventions: Procedure: immediate removal of in-dwelling catheter, Procedure: 24 hours delayed removal of catheter | Intervention Type: PROCEDURE; Name: immediate removal of in-dwelling catheter; Assigned to Arm(s): removal of catheter | Intervention Type: PROCEDURE; Name: 24 hours delayed removal of catheter; Assigned to Arm(s): removal of catheter
B: Arm Label: Study group 1; Type: EXPERIMENTAL; Interventions: Other: Removal of urethral catheter | Arm Label: Study group 2; Type: OTHER; Interventions: Other: Removal of urethral catheter | Intervention Type: OTHER; Name: Removal of urethral catheter; Assigned to Arm(s): Study group 1, Study group 2
C: Arm Label: Early removal group; Type: EXPERIMENTAL; Interventions: Procedure: Early removal group | Arm Label: Normal removal group; Type: ACTIVE_COMPARATOR; Interventions: Procedure: Normal removal group | Intervention Type: PROCEDURE; Name: Early removal group; Assigned to Arm(s): Early removal group | Intervention Type: PROCEDURE; Name: Normal removal group; Assigned to Arm(s): Normal removal group
D: Arm Label: 24 hour postop catheter removal; Type: EXPERIMENTAL; Interventions: Drug: Prazosin given 6 hours prior to catheter removal in the 24 hour group | Arm Label: 72 hour postoperative catheter removal; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: DRUG; Name: Prazosin given 6 hours prior to catheter removal in the 24 hour group; Assigned to Arm(s): 24 hour postop catheter removal

Answer: A