Duration of postoperative catheterization: A randomized, doubleblind trial comparing two catheter management protocols and the effect of bethanechol chloride

A randomized trial of two postoperative suprapubic catheter clamping protocols was undertaken to compare their effect on the duration of both postoperative indwelling catheter time and hospital stay. In addition, patients were given either bethanechol chloride or placebo in a double-blind fashion to test the proposal that the use of bethanechol chloride would enhance return of bladder function and shorten postoperative catheter time. Forty-nine patients who underwent an anterior repair, Burch colposuspension or Marshall-Marchetti-Krantz (MMK) procedure were preoperatively randomized to one of two catheter clamping protocols. Protocol I involved a continuous clamping regimen with residuals measured with each void. Protocol II involved an intermittent clamping (‘bladder training’) regimen with residuals measured at specified intervals while the catheter was in place. Each patient received either bethanechol chloride or placebo in identical capsules. Protocol I significantly shortened the duration of postoperative catheterization (P<0.01). The use of bethanechol chloride prolonged the duration of catheterization in Protocol I patients and made no difference in Protocol II patients. We would recommend our simplified catheter protocol and the avoidance of bethanechol chloride in the management of indwelling catheters after surgery for urinary incontinence.