Résumé
Une étude prospective randomisée chez les patients opérés pour une arthrodèse rachidienne a permis d'étudier l'effet du sondage uréthral à demeure sur les complications urinaires. Deux groupes de patients ont été formés; 16 d'entre eux ont reçu une sonde urinaire à demeure et 16 autres n'ont pas été sondés. Tous les patients ont été en cas de nécessité, sondés de manière intermittente dans la phase postopératoire. Sept des patients du groupe sondé présentaient des cultures positives à un taux ≥100000 bactéries vivantes/ml, contre deux patients seulement dans le groupe non sondé (ns). Un autre groupe de 4 patients du groupe non sondé présentaient des cultures positives à un taux ≥10000 bactéries vivantes/ml. Treize patients du groupe sondé et 14 patients du groupe non sondé présentaient des tests à la bandelette positifs. La plus grande quantité d'urine recueillie chez chaque patient lors d'un cathétérisme intermittent ne différait pas de manière significative entre les groupes. Cependant, chez trois patients du groupe non sondé les volumes dépassaient 1000 ml. Ainsi, quel qu'ait été le traitement, 84% des patients ont eu une surveillance bactériurique par des tests à la bandelette. Le sondage urinaire à demeure au cours de l'opération ne semble pas provoquer plus de complications infectieuses que l'absence de drainage vésical peropératoire; les avantages liés à la diminution du risque de lésion vésicale par distension et à la surveillance plus précise de l'équilibre liquidien incitent à utiliser ce type de cathétérisme.
Summary
In a prospective randomized study the effect of the use of an intraoperative indwelling urethral catheter (IUC) on urinary complications was investigated in patients undergoing spinal fusion. Two groups were formed; 16 patients received an intraoperative IUC and 16 patients had no intraoperative catheter (NC). All patients were, if necessary, intermittently catheterized in the postoperative period. Seven of the patients in the IUC group had positive cultures, defined as ≥100000 CFU/ml, compared with two patients in the NC group (n.s.). Another four patients in the NC group had cultures ≥10000 CFU/ml. Thirteen patients in the IUC group and 14 patients in the NC group had positive dip slides. The largest received urine volume in each patient at one intermittent catheterization did not differ significantly between the groups. However, in three patients in the NC group the volumes exceeded 1000 ml. Thus, irrespective of treatment dip slides showed bacteriuria in 84% of the patients. Perioperative indwelling catheters do not seem to cause many more infection complications than no bladder drainage during surgery, and the advantages of reduced risk of bladder distension injury and more accurate monitoring of fluid balance suggest their use.
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Normelli, H., Aaro, S., Hedlund, R. et al. Urethral catheterization in spinal surgery: a randomized prospective study. Eur Spine J 2, 132–135 (1993). https://doi.org/10.1007/BF00301409
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DOI: https://doi.org/10.1007/BF00301409