A randomized controlled trial comparing early versus late catheter removal after radical hysterectomy

Radical hysterectomy is the primary mode of therapy for early stage cervical cancer.Urinary tract complications are common following radical hysterectomy.These include prolonged bladder dysfunction resulting in urinary retention ,diminished bladder sensation ,urinary infection and fistula formation.The etiology of these comlicaions is thought to be due to the extensive dissection during the procedure leading to sensory or motor abnormalities of the detrusor muscle or a combination of both which can be exacerbated by the local haematoma, edema, and fibrosis.However the pathophysiology of bladder dysfunctiion remains poorly understood.Decreased bladder sensation and urinary retention are observed in some women requiring prolonged bladder catheterisation, intermittent self catheterisation, or supra pubic pressure to empty the bladder completely.Prolonged bladder catheterisation is a cornerstone of post operative managementafter radical hysterectomy with a view to prvent these bladder complications.

The incidence of bladder dysfunction after radical hysterectomy varies from 12% to 85% depending on the method used in the evaluation of bladder dysfunction, duration of follow up. In addition the rate of bladder dysfunction depends on the radicality of surgery.Nerve sparing readical hysterectomy that is currently being practised should reduce the bladder dysfunction.Currently controversy exists with regard to theduration of bladder drainage and choice of catheter used in bladder drainage.

Although survival outcomes of women with early stage cervical cancer after radical hysterectomy are excellent, surgery was frequently associated with post operative complications particularly bladder dysfunction that affects quality  of life.Also there is evidence that prolonged bladder  catheterisaton may have adverse effeccts such as delayed ambulation and urinary tract infections.

all patients undergoing radical hysterctomy at our center will be invited to participate in this study and will have an equal chance of early or late catheter removal.The early group will have catheter removed before discharge on 4th +/- 1 day and in the late group after discharge on 10th+/-1 day.Aftr catheter removal sample of urine will be sent for culture for all patients.If patient has a voiding problem the catheter will be put back.Any woman continuing to have bladder dysfunction will be taught clean intermittent self catheterisation and referred to urologist if problem persists after a month.