An RCT to Determine Impact of Catheter Type on UTIs After Pelvic Floor Surgery

Objectives: To investigate the efficacy of silver-coated silicone transurethral indwelling (TICs) in reducing the incidence of catheter-associated UTIs (CAUTIs) compared to standard silicone TICs in women with postoperative urinary retention (POUR) following pelvic floor surgery (PFS).

Methods: This was a double-blind, randomized controlled trial of women undergoing PFS between June 2022 and February 2024 with POUR. Participants were randomized to a silver-coated silicone TIC or a standard silicone TIC. All patients discharged home with a catheter were prescribed cranberry and methenamine to be taken twice-a-day for the first 7 days post-operatively for UTI prevention. Patients removed their catheters at home and were assigned a removal date between postoperative days 3-7. The primary outcome was the incidence of symptomatic, culture-proven UTI (defined as more than 1,000 colony forming units per millimeter of a uropathogenic bacteria) within 30 days of surgery. Secondary outcomes included the categorization of uropathogens as well as adverse symptoms potentially related to the catheter.

Results: Of 310 subjects randomized, 303 were included in the intention-to-treat analysis; 154 in the control group and 149 in the silver catheter group. The groups were similar in baseline demographics with a median age of 63 years. There was no difference in intraoperative data. Of the study population, 46% underwent a procedure for prolapse, 54% underwent incontinence procedures alone, and 39% had a combined procedure. For our primary outcome, 56 patients in the control group and 52 patients in the silver catheter group, were diagnosed with a UTI (36.4% vs. 34.9%; p=0.81). Silver-coated TIC did not reduce the incidence of symptomatic culture-proven UTIs following PFS. Urine cultures were obtained for 248 symptomatic episodes. There was a total of 18 patients, 9 in each arm, who received antibiotics but ultimately had a negative urine culture within 30 days. Prolonged retention greater than 1 week was noted in 55 controls and 40 silver catheter subjects (35.7% and 26.8%; p=0.11). As expected, we found a positive correlation between UTI rate and length of catheter use greater than 1 week with 67% of women developing a UTI (p= < 0.001). In patients requiring a catheter longer than 1 week, between 65.5% and 70% (p=0.82) developed a UTI within 30 days. No patient-reported adverse reactions specific to the silver catheter were noted. Analysis of the bacteria categories demonstrated Escherichia coli was the most represented uropathogen, found in 48% of control urine cultures and 42% of silver catheter. Klebsiella was the second most common organism for both groups.

Conclusions: There was no difference in incidence of symptomatic, culture-confirmed CAUTIs in patients that received silver-coated silicone TICs compared to standard silicone TICs in women undergoing PFS. This continues to be an important area for further research for patients undergoing PFS.