Effect of Intraoperative Urinary Catheter Use on Postoperative Urinary Retention After Laparoscopic Inguinal Hernia Repair: A Randomized Clinical Trial

Key PointsQuestionWhat is the effect of intraoperative urinary catheters on urinary retention after laparoscopic inguinal hernia repair? FindingsIn this randomized clinical trial, there were no stastistically significant differences in postoperative urinary retention rates between the catheter and no-catheter groups. MeaningIntraoperative urinary catheters did not reduce the risk of postoperative urinary retention during laparoscopic inguinal hernia repair and thus their use may be reconsidered. This randomized clinical trial evaluates the effect of intraoperative catheter use on urinary retention following laparoscopic inguinal hernia repair. ImportanceUrinary catheters are commonly placed during laparoscopic inguinal hernia repair as a presumed protection against postoperative urinary retention (PUR), one of the most common complications following this operation. Data from randomized clinical trials evaluating the effect of catheters on PUR are lacking. ObjectiveTo investigate the effect of intraoperative catheters on PUR after laparoscopic inguinal hernia repair. Design, Setting, and ParticipantsThis 2-arm registry-based single-blinded randomized clinical trial was conducted at 6 academic and community hospitals in the US from March 2019 to March 2021 with a 30-day follow-up period following surgery. All patients who presented with inguinal hernias were assessed for eligibility, 534 in total. Inclusion criteria were adult patients undergoing laparoscopic, elective, unilateral, or bilateral inguinal hernia repair. Exclusion criteria were inability to tolerate general anesthesia and failure to understand and sign the written consent form. A total of 43 patients were excluded prior to intervention. InterventionsPatients in the treatment arm had placement of a urinary catheter after induction of general anesthesia and removal at the end of procedure. Those in the control arm had no urinary catheter placement. Main Outcomes and MeasuresPUR rate. ResultsOf the 491 patients enrolled, 241 were randomized to catheter placement, and 250 were randomized to no catheter placement. The median (IQR) age was 61 (51-68) years, and 465 participants (94.7%) were male. Overall, 44 patients (9.1%) developed PUR. There was no difference in the rate of PUR between the catheter and no-catheter groups (23 patients [9.6%] vs 21 patients [8.5%], respectively; P=.79). There were no intraoperative bladder injuries. In the catheter group, there was 1 incident of postoperative urethral trauma in a patient who presented to the emergency department with PUR leading to a suprapubic catheter placement. Conclusions and RelevanceIntraoperative urinary catheters did not reduce the risk of PUR after laparoscopic inguinal hernia repair. While their use did not appear to be associated with a high rate of iatrogenic complications, there may be a low rate of catastrophic complications. In patients who voided urine preoperatively, catheter placement did not appear to confer any advantage and thus their use may be reconsidered. Trial RegistrationClinicalTrials.gov Identifier: NCT03835351