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CAtheter Management and complications for symptomatic Postpartum Urinary Retention

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Symptomatic postpartum urinary retention (PUR) is a common complication with a varying prevalence, from 0.5 18%. Women who are diagnosed with symptomatic PUR are unable to void within 6 hours after the delivery or have clinical signs of a bladder retention within 6 hours. Besides the lack of standardized checks of postpartum urinary retention, agreement about definition, diagnostics and treatment is missing worldwide. Postpartum urinary retention often resolves quickly; most treated women can void spontaneously within a few days. However, some women have to learn intermittent self catheterization and continue this up to several months.
Untreated and unrecognized postpartum urinary retention can lead to serious complications and overdistension of the bladder can have long term effects.
In this study we compare two treatments for symptomatic postpartum urinary retention, indwelling catheters versus intermittent catheterization. Both of them are part of standard daily care and are used worldwide. We will evaluate which treatment makes PUR resolve.

Study design
Multicentre prospective randomised controlled trial.

Study population
Women who deliver in the participating hospitals, vaginally and by caesarean section, 18 years and older and are unable to void within 6 hours postpartum.

Women who are diagnosed with overt postpartum urinary retention will be randomized between an indwelling catheter or intermittent bladder catheterization.

Outcome measures
The main point of this trial is bladder related quality of life at 3 months after delivery. Secondary outcomes will be prevalence of urinary tract infections, creation of a risk profile and time to normal micturition with different treatments.

Power/data analysis
A difference between both treatment groups of 3 points in the obstructive micturition domain (of the validated quality-of-life questionnaire) is considered to be a clinically relevant difference between both groups.
With a power of 90%, level of 0.05, and a standard deviation of 3.75, the calculated sample size necessary is 68 (34 in each group) using a two-sided two-sample t-test. Assuming a drop out of 15 %, we aim to include 85 women in this study

Time schedule
18 Months. Three months of preparation, twelve months inclusion, three months analysis and report.

Dr. J.P.W.R. Roovers, gynaecologist, AMC Amsterdam
Drs. F.E.M. Mulder, research physician, AMC Amsterdam

Drs. F.E.M. Mulder, research physician
AMC Amsterdam
020 56 63453
email: campur@studies-obsgyn.nl