Is it necessary to catheterise the bladder routinely before gynaecological laparoscopic surgery?

BACKGROUND: Catheterisation of the bladder was routinely performed before gynaecological laparoscopy, but such an established practice is not evidence based and may lead to an increase in postoperative urinary symptoms and urinary tract infection. AIMS: To compare routine urethral catheterisation and non-catheterisation before laparoscopic surgery with respect to bladder injury, postoperative urinary symptoms and urinary tract infection (UTI). METHODS: This was a prospective, double blind randomised study. All women undergoing gynaecological laparoscopy, both elective and emergency, were invited to participate in the study. Cases involving bladder dissection, second trimester pregnancy and those who could not void preoperatively were excluded. Patients were randomly allocated to catheterise group and non-catheterise group. Requirement of catheterisation in the non-catheterise group, bladder injury, postoperative catheterisation, urinary symptoms and UTI were studied. RESULTS: Two hundred and seventy-nine women were recruited of whom 262 were suitable for final analysis. Each group contained 131 cases. Patient characteristics and operative parameters were comparable in both groups. There was no bladder injury. Four percent of the women in the non-catheterise group needed catheterisation and catheterisation was significantly associated with surgery longer than 90 min (P < 0.001). Postoperative UTI was insignificantly reduced in the non-catheterised group. When postoperative urinary symptoms and urinary tract infections were studied as a composite outcome, they were statistically significantly reduced in the non-catheterise group (P = 0.017). CONCLUSIONS: The policy of non-catheterisation before gynaecological laparoscopic surgery is safe and feasible. Although the reduction in UTI is insignificant, the overall postoperative urinary problems (urinary symptoms or UTI) are reduced significantly.

Primary omental ectopic pregnancy.

Omental ectopic pregnancy is a rare form of ectopic pregnancy. Presented here is a case primary omental ectopic pregnancy according to Studdiford's criteria. This patient presented with epigastric pain and anemia without vaginal bleeding, lower abdominal or pelvic pain. Pregnancy status was confirmed after admission. Transvaginal ultrasound examination revealed intrauterine contraceptive device in situ and a large amount of free peritoneal fluid, but no intrauterine sac or adnexal mass. Laparoscopy was performed but pelvic pathology did not account for the 2500 mL of haemoperitoneum. Laparotomy was carried out and partial omentectomy was performed.