Comparing clean intermittent catheterisation and transurethral indwelling catheterisation for incomplete voiding after vaginal prolapse surgery: a multicentre randomised trial

the antibiotic sensitivities that were obtained postoperatively, different from the intraoperative antibiotics prescribed. We also note that the postvoid residuals were checked at first void after removal of indwelling transurethral catheter. What we are really interested to know is whether any conservative measures were carried out (such as double voiding, adequate pain relief) before consideration of randomisation. The quoted incidence of voiding dysfunction in this study was 14% (147/1037). Given the mean age of women in the study was only 60 years, we feel that having a low threshold for commencing either clean intermittent catheterisation or transurethral indwelling catheterisation could have reduced this abnormally high figure of voiding dysfunction. The lead author, in a previous study, describes the common practice in the Netherlands regarding catheterisation in women undergoing prolapse surgery. In this survey, 60% of all the respondents would use two postvoid residuals measurements to diagnose urinary retention. We are concerned if, by taking one postvoid residual before randomisation, the authors have been overzealous. A recent study in the surgical treatment of pelvic floor disorders in women aged more than 75 years found only 5.8% urinary retention, and only one woman (0.7%) was discharged with an indwelling Foley catheter because of voiding dysfunction. Did the authors find any preoperative risk factor that could predict postoperative voiding dysfunction after pelvic floor surgery? Recently published data in prolapse repair using mesh reported high preoperative anterior-stage prolapse and combined anterior and posterior compartment repairs are to be associated with postoperative urinary retention. Even though table 1 in ref. 1 shows the baseline characteristics of the study groups and gives a suggestion of the type of operations performed, it does not provide information regarding the pre-existing voiding dysfunction, if any, of the women. However, it is interesting to note that in this study the duration of transurethral indwelling catheterisation chosen was 3 days, which we feel should have been 2 days. The survey in the Netherlands reported that 56% of respondents usually leave transurethral indwelling catheterisation for 2 days (32/57). j