{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T01:20:56Z","timestamp":1770513656166,"version":"3.49.0"},"reference-count":31,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100019124","name":"Asia University Hospital","doi-asserted-by":"crossref","award":["11451016"],"award-info":[{"award-number":["11451016"]}],"id":[{"id":"10.13039\/100019124","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Postoperative bladder drainage is commonly required following major pelvic or abdominal surgery. Existing evidence indicates substantial variation in urinary tract infection (UTI) risk across different catheterization methods. However, the comparative effectiveness of indwelling Foley catheterization (IFC), suprapubic catheterization (SPC), and intermittent catheterization (IC) remains uncertain. Methods: We conducted a Bayesian network meta-analysis of randomized controlled trials (RCTs) to compare UTI incidence associated with different urinary drainage methods, including IFC, SPC, and IC. PubMed and the Cochrane Library were searched to identify eligible RCTs published from January 2010 to November 2025. Trials comparing at least two of the three catheterization routes following major pelvic or abdominal surgery were included. The primary outcome was the rate of UTI. A Bayesian network meta-analysis with a random-effects model was conducted using the gemtc package in R 4.5.1 and RStudio2026.01.0. The quality of evidence was evaluated using the GRADE approach. Results: Ten RCTs involving 1242 patients met the eligibility criteria. Both IC and SPC demonstrated a reduced risk of UTI compared with IFC. Based on indirect evidence, SPC was not associated with a statistically significant reduction in postoperative UTI compared with IC, with considerable uncertainty in the effect estimate (OR = 0.53, 95% CrI 0.09\u20132.69). Overall, IC and SPC showed favorable trends in reducing catheter-related complications compared with IFC. Conclusions: This network meta-analysis suggests that SPC and IC may be more effective than IFC in reducing the risk of postoperative UTI following major pelvic or abdominal surgery. However, further high-quality randomized controlled trials that integrate urinary drainage methods with bladder rehabilitation interventions are needed to identify the optimal management strategy for this patient population.<\/jats:p>","DOI":"10.3390\/life16020280","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T15:24:19Z","timestamp":1770305059000},"page":"280","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Urinary Tract Infection Rates Associated with Different Catheterization Methods Following Major Pelvic or Abdominal Surgery: A Bayesian Network Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5255-4505","authenticated-orcid":false,"given":"Thanh-Nhan","family":"Doan","sequence":"first","affiliation":[{"name":"Department of General Surgery, Vinmec Da Nang International Hospital, Vinmec Healthcare System, Hanoi 11622, Vietnam"},{"name":"Faculty of Health Sciences, Mekong University, Vinh Long 85000, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6241-9736","authenticated-orcid":false,"given":"Thi-Hong-Phuc","family":"Le","sequence":"additional","affiliation":[{"name":"Department of Traditional Medicine and Rehabilitation, Nghe An Oncology Hospital, Vinh City 460000, Vietnam"},{"name":"Specialist Level I in Rehabilitation Medicine, Hanoi Medical University, Ha Noi 100000, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3540-6225","authenticated-orcid":false,"given":"Li-Wei","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung 404327, Taiwan"},{"name":"Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung 404328, Taiwan"},{"name":"Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung 413305, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1001\/archsurg.143.6.551","article-title":"Indwelling urinary catheter use in the postoperative period: Analysis of the National Surgical Infection Prevention Project data","volume":"143","author":"Wald","year":"2008","journal-title":"Arch. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Wagner, J., Eiken, B., Haubitz, I., Lichthardt, S., Matthes, N., L\u00f6b, S., Klein, I., Germer, C.-T., and Wiegering, A. (2019). Suprapubic bladder drainage and epidural catheters following abdominal surgery: A risk for urinary tract infections. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0209825"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/S0022-5347(17)55596-2","article-title":"Catheter-associated urinary tract infections in surgical patients: A controlled study on the excess morbidity and costs","volume":"124","author":"Givens","year":"1980","journal-title":"J. Urol."},{"key":"ref_4","first-page":"e15111","article-title":"Risk factors and outcomes of postoperative catheter-associated urinary tract infection in colorectal surgery patients: A retrospective cohort study","volume":"13","author":"Farsi","year":"2021","journal-title":"Cureus"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1016\/j.juro.2017.07.069","article-title":"Comparison of urinary tract infection rates associated with transurethral catheterization, suprapubic tube, and clean intermittent catheterization in the postoperative setting: A network meta-analysis","volume":"198","author":"Han","year":"2017","journal-title":"J. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1007\/s00192-018-3791-3","article-title":"The incidence of urinary tract infection of different routes of catheterization following gynecologic surgery: A systematic review and meta-analysis of randomized controlled trials","volume":"30","author":"Li","year":"2019","journal-title":"Int. Urogynecol. J."},{"key":"ref_7","first-page":"CD004203","article-title":"Urinary catheter policies for short-term bladder drainage in adults","volume":"2015","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.eururo.2015.07.071","article-title":"Summary of European Association of Urology (EAU) guidelines on neuro-urology","volume":"69","author":"Groen","year":"2016","journal-title":"Eur. Urol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1086\/660765","article-title":"Reporting catheter-associated urinary tract infections: Denominator matters","volume":"32","author":"Wright","year":"2011","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_10","unstructured":"European Association of Urology (EAU) (2024). EAU Guidelines on Urological Infections, European Association of Urology (EAU)."},{"key":"ref_11","first-page":"CD006008","article-title":"Intermittent catheterisation for long-term bladder management","volume":"8","author":"Prieto","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"744","DOI":"10.21037\/tau-23-220","article-title":"Effects of clean intermittent catheterization and transurethral indwelling catheterization on the management of urinary retention after gynecological surgery: A systematic review and meta-analysis","volume":"12","author":"Wang","year":"2023","journal-title":"Transl. Androl. Urol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1097\/AOG.0b013e3182657f0d","article-title":"Suprapubic compared with transurethral bladder catheterization for gynecologic surgery: A systematic review and meta-analysis","volume":"120","author":"Healy","year":"2012","journal-title":"Transl. Obstet. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"777","DOI":"10.7326\/M14-2385","article-title":"The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: Checklist and explanations","volume":"162","author":"Hutton","year":"2015","journal-title":"Ann. Intern. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.12968\/bjon.2010.19.Sup8.79063","article-title":"Randomized controlled trial of urethral versus suprapubic catheterization","volume":"19","author":"Dixon","year":"2010","journal-title":"Br. J. Nurs."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1007\/s00192-010-1221-2","article-title":"Postoperative infections due to bladder catheters after anterior colporrhaphy: A prospective, randomized three-arm study","volume":"21","author":"Kringel","year":"2010","journal-title":"Int. Urogynecol. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1111\/j.1471-0528.2011.03056.x","article-title":"Patient preferences for clean intermittent catheterisation and transurethral indwelling catheterisation for treatment of abnormal post-void residual bladder volume after vaginal prolapse surgery","volume":"118","author":"Hakvoort","year":"2011","journal-title":"BJOG"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1159\/000323827","article-title":"A comparison of suprapubic and transurethral catheterization on postoperative urinary retention after vaginal prolapse repair: A randomized controlled trial","volume":"72","author":"Stekkinger","year":"2011","journal-title":"Gynecol. Obstet. Investig."},{"key":"ref_19","first-page":"22","article-title":"Role of clean intermittent self-catheterisation in the prevention of recurrent urethral strictures after internal optical urethrotomy","volume":"23","author":"Khan","year":"2011","journal-title":"J. Ayub Med. Coll. Abbottabad"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1016\/j.ijnurstu.2013.05.007","article-title":"Intermittent versus indwelling urinary catheterisation in hip surgery patients: A randomised controlled trial with cost-effectiveness analysis","volume":"50","author":"Gustafsson","year":"2013","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1007\/s00345-016-1883-6","article-title":"Postoperative patient comfort in suprapubic drainage versus transurethral catheterization following robot-assisted radical prostatectomy: A prospective randomized clinical trial","volume":"35","author":"Harke","year":"2017","journal-title":"World J. Urol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"507.e1","DOI":"10.1016\/j.ajog.2019.05.014","article-title":"Catheter burden following urogynecologic surgery","volume":"221","author":"Dieter","year":"2019","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e27741","DOI":"10.1016\/j.heliyon.2024.e27741","article-title":"Evaluation of the use versus nonuse of urinary catheterization during laparoscopic adnexal surgery: A randomized controlled trial","volume":"10","author":"Jia","year":"2024","journal-title":"Heliyon"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s10151-024-02950-2","article-title":"GRECCAR study Group. Suprapubic versus transurethral catheterization for bladder drainage in male rectal cancer surgery (GRECCAR10), a randomized clinical trial","volume":"28","author":"Trilling","year":"2024","journal-title":"Tech. Coloproctol."},{"key":"ref_25","first-page":"CD004203","article-title":"Urethral (indwelling or intermittent) or suprapubic routes for short-term catheterisation in hospitalised adults","volume":"2015","author":"Kidd","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_26","unstructured":"Grabe, M., Bartoletti, R., Bjerklund-Johansen, T.E., \u00c7ek, M., Naber, K.G., Tenke, P., and Wagenlehner, F. (2015). Guidelines on Urological Infections, European Association of Urology."},{"key":"ref_27","unstructured":"European Association of Urology (EAU) (2015). EAU Guidelines: Neuro-Urology and Bladder Management, EAU."},{"key":"ref_28","unstructured":"Centers for Disease Control and Prevention (CDC) (2026, January 22). Summary of Recommendations: Guideline for Prevention of Catheter-Associated Urinary Tract Infections (CAUTI), Available online: https:\/\/www.cdc.gov\/infection-control\/hcp\/cauti\/summary-of-recommendations.html."},{"key":"ref_29","unstructured":"(2019). Bladder Drainage and Urinary Protective Methods, Obgyn Key."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1086\/650482","article-title":"Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America","volume":"50","author":"Hooton","year":"2009","journal-title":"Clin. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.ijnurstu.2018.09.007","article-title":"Bladder training prior to urinary catheter removal in total joint arthroplasty: A randomized controlled trial","volume":"89","author":"Markopoulos","year":"2019","journal-title":"Int. J. Nurs. Stud."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/2\/280\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T05:20:18Z","timestamp":1770441618000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/2\/280"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,5]]},"references-count":31,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["life16020280"],"URL":"https:\/\/doi.org\/10.3390\/life16020280","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,5]]}}}