.: ORİJİNAL ARAŞTIRMA
Effects of Urinary Catheter Clamping After Cesarean Section on Urinary Retention and Urinary Tract Infection
Sezaryen Sonrası Üriner Kateter Klemplemenin Üriner Retansiyon ve İdrar Yolu Enfeksiyonu Üzerine Etkileri
J Reconstr Urol. 2020;10(2):35-43
doi: 10.5336/urology.2020-75010
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: This study was planned to investigate the effect of intermittent clamping of the urinary catheter after cesarean section and exercising the detrusor muscle on the post-void residual urine volume and reduction of the risk of urinary tract infection in the early stage. Material and Methods: This randomized controlled study was carried out with 100 primiparous pregnant women who were to undergo elective cesarean section between January 2019 and January 2020. The participants were randomly assigned into 2 groups: the experimental group including 50 patients who underwent urinary catheter clamping 3 times after the postoperative 3rd hour, by turning off the urinary catheter for 3 hours, and then turning it on for 5 minutes and the control group including 50 patients who did not undergo urinary catheter clamping. The study data were collected with the maternal information form and Urinary Distress Inventory (UDI-6). The UDI-6 was used to assess the subjective voiding difficulty. The primary outcome of the present study was to determine whether exercising the detrusor muscle decreased post-void residual urine volume in patients having undergone cesarean section. The secondary results were the incidence of urinary tract infections and subjective symptoms experienced by the patients. Results: According to the comparison of the post-void residual urine volume in the experimental (E) and control (C) groups, no significant difference was observed between the groups on the first day [E=10 (20%), C=12 (24%) (p=0.629)] and in the first week [E=2 (4%), C=3 (6%) (p=1.000)]. In the sixth week, no post-void residual urine volume was observed in any patient in either group. There was no statistical difference between the groups in percentage change values in time dependent intragroup UDI-6 scores (p=0.453). While the median change in the experimental group was 50.60%, this value was obtained as 58.93% in the control group. While the rate of the participants with positive urine culture in the experimental group was 6%, it was 4% in the control group, and there was no significant difference between the groups (p=1.000). Conclusion: In our study, urinary catheter clamping has no reducing effect on post-void residual urine volume, urinary tract infection and subjective voiding difficulty.
Keywords: Bladder exercising; urinary catheter clamping; urinary retention; cesarean section
Objective: This study was planned to investigate the effect of intermittent clamping of the urinary catheter after cesarean section and exercising the detrusor muscle on the post-void residual urine volume and reduction of the risk of urinary tract infection in the early stage. Material and Methods: This randomized controlled study was carried out with 100 primiparous pregnant women who were to undergo elective cesarean section between January 2019 and January 2020. The participants were randomly assigned into 2 groups: the experimental group including 50 patients who underwent urinary catheter clamping 3 times after the postoperative 3rd hour, by turning off the urinary catheter for 3 hours, and then turning it on for 5 minutes and the control group including 50 patients who did not undergo urinary catheter clamping. The study data were collected with the maternal information form and Urinary Distress Inventory (UDI-6). The UDI-6 was used to assess the subjective voiding difficulty. The primary outcome of the present study was to determine whether exercising the detrusor muscle decreased post-void residual urine volume in patients having undergone cesarean section. The secondary results were the incidence of urinary tract infections and subjective symptoms experienced by the patients. Results: According to the comparison of the post-void residual urine volume in the experimental (E) and control (C) groups, no significant difference was observed between the groups on the first day [E=10 (20%), C=12 (24%) (p=0.629)] and in the first week [E=2 (4%), C=3 (6%) (p=1.000)]. In the sixth week, no post-void residual urine volume was observed in any patient in either group. There was no statistical difference between the groups in percentage change values in time dependent intragroup UDI-6 scores (p=0.453). While the median change in the experimental group was 50.60%, this value was obtained as 58.93% in the control group. While the rate of the participants with positive urine culture in the experimental group was 6%, it was 4% in the control group, and there was no significant difference between the groups (p=1.000). Conclusion: In our study, urinary catheter clamping has no reducing effect on post-void residual urine volume, urinary tract infection and subjective voiding difficulty.
Keywords: Bladder exercising; urinary catheter clamping; urinary retention; cesarean section
ÖZET
Amaç: Bu çalışma, sezaryen sonrası idrar sondasının aralıklı olarak klemplenmesi ve detrusor kasının egzersizinin rezidüel idrar hacmi üzerine ve erken evrede idrar yolu enfeksiyonu riskini azaltmada etkisini araştırmak için planlandı. Gereç ve Yöntemler: Bu randomize kontrollü çalışma, Ocak 2019-Ocak 2020 tarihleri arasında elektif sezaryen ameliyatı geçirecek olan 100 primipar gebe kadınla gerçekleştirildi. Katılımcılar rastgele 2 gruba ayrıldı: Üriner kateter klempleme uygulanan 50 hastadan oluşan deney grubu (ameliyat sonrası 3. saatten sonra 3 kez, idrar sondasını 3 saat boyunca kapatarak ve sonra 5 dk boyunca açacak şekilde) ve idrar sondası klemplenmemiş 50 hastadan oluşan kontrol grubu. Çalışma verileri, maternal bilgi formu ve Üriner Sıkıntı Envanteri [Urinary Distress Inventory (UDI6)] ile toplanmıştır. UDI-6, subjektif işeme zorluğunu değerlendirmek için kullanıldı. Bu çalışmanın birincil sonucu, sezaryen uygulanan hastalarda detrusor kas egzersizi ile rezidüel idrar hacminde azalma olup olmadığını belirlemekti. İkincil sonuçlar, idrar yolu enfeksiyonu insidansı ve hastaların yaşadığı öznel semptomlardı. Bulgular: Deney (D) ve kontrol (K) gruplarında boşluk sonrası rezidüel idrar hacminin karşılaştırılmasına göre, ilk gün gruplar arasında anlamlı bir fark gözlenmedi [D=10 (%20), K=12 (%24), (p=0,629)]. İlk haftada [D=2 (%4), K=3 (%6), (p=1,000)] ve 6. haftada, her iki grupta da hiçbir hastada rezidüel idrar hacmi gözlenmedi. Gruplar arasında, zamana bağlı grup içi UDI-6 skorlarında yüzde değişim değerleri açısından istatistiksel fark yoktu (p=0,453). Deney grubundaki ortalama değişim %50,60 iken, kontrol grubunda bu değer %58,93 olarak elde edildi. Deney grubunda pozitif idrar kültürü olan katılımcıların oranı %6 iken, kontrol grubunda %4 olup, gruplar arasında anlamlı fark yoktu (p=1,000). Sonuç: Çalışmamızda, idrar sondası klempinin rezidüel idrar hacmi, idrar yolu enfeksiyonu ve subjektif idrar yapma zorluğu üzerinde azaltıcı etkisi yoktur.
Anahtar Kelimeler: Mesane egzersizi; idrar sondası klempleme; idrar retansiyonu; sezaryen
Amaç: Bu çalışma, sezaryen sonrası idrar sondasının aralıklı olarak klemplenmesi ve detrusor kasının egzersizinin rezidüel idrar hacmi üzerine ve erken evrede idrar yolu enfeksiyonu riskini azaltmada etkisini araştırmak için planlandı. Gereç ve Yöntemler: Bu randomize kontrollü çalışma, Ocak 2019-Ocak 2020 tarihleri arasında elektif sezaryen ameliyatı geçirecek olan 100 primipar gebe kadınla gerçekleştirildi. Katılımcılar rastgele 2 gruba ayrıldı: Üriner kateter klempleme uygulanan 50 hastadan oluşan deney grubu (ameliyat sonrası 3. saatten sonra 3 kez, idrar sondasını 3 saat boyunca kapatarak ve sonra 5 dk boyunca açacak şekilde) ve idrar sondası klemplenmemiş 50 hastadan oluşan kontrol grubu. Çalışma verileri, maternal bilgi formu ve Üriner Sıkıntı Envanteri [Urinary Distress Inventory (UDI6)] ile toplanmıştır. UDI-6, subjektif işeme zorluğunu değerlendirmek için kullanıldı. Bu çalışmanın birincil sonucu, sezaryen uygulanan hastalarda detrusor kas egzersizi ile rezidüel idrar hacminde azalma olup olmadığını belirlemekti. İkincil sonuçlar, idrar yolu enfeksiyonu insidansı ve hastaların yaşadığı öznel semptomlardı. Bulgular: Deney (D) ve kontrol (K) gruplarında boşluk sonrası rezidüel idrar hacminin karşılaştırılmasına göre, ilk gün gruplar arasında anlamlı bir fark gözlenmedi [D=10 (%20), K=12 (%24), (p=0,629)]. İlk haftada [D=2 (%4), K=3 (%6), (p=1,000)] ve 6. haftada, her iki grupta da hiçbir hastada rezidüel idrar hacmi gözlenmedi. Gruplar arasında, zamana bağlı grup içi UDI-6 skorlarında yüzde değişim değerleri açısından istatistiksel fark yoktu (p=0,453). Deney grubundaki ortalama değişim %50,60 iken, kontrol grubunda bu değer %58,93 olarak elde edildi. Deney grubunda pozitif idrar kültürü olan katılımcıların oranı %6 iken, kontrol grubunda %4 olup, gruplar arasında anlamlı fark yoktu (p=1,000). Sonuç: Çalışmamızda, idrar sondası klempinin rezidüel idrar hacmi, idrar yolu enfeksiyonu ve subjektif idrar yapma zorluğu üzerinde azaltıcı etkisi yoktur.
Anahtar Kelimeler: Mesane egzersizi; idrar sondası klempleme; idrar retansiyonu; sezaryen
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