***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE It is unclear if any catheterisation is necessary after vaginal surgery for pelvic organ prolapse . The aim of this study was to determine if indwelling catheterisation is necessary after these procedures . STUDY DESIGN A r and omised controlled trial of immediate post-operative removal of catheter compared to a suprapubic catheter ( SPC )  after vaginal prolapse surgery . In the Suprapubic group the catheter was left on free drainage until a voiding trial was commenced at 48h . Women in the immediate removal group underwent in/out catheterisation only if they had not voided by 8h after surgery to ensure the bladder did not over-distend . RESULTS 55 % ( n=17 ) of patients in the immediate removal group did not require catheterisation postoperatively . A further 13 ( 42 % ) patients only required one in/out catheterisation 8h post operatively . In the immediate removal group duration of catheterisation was significantly shorter ( median 0h , IQR 0 - 8h , range 0 - 16h ) vs ( 6days ( IQR 2 - 8days , range 2 - 19h ) p=0.001 ) . The duration of hospital stay ( 7days ( range 3 - 16 ) vs. 9 ( range 3 - 27 ) p=0.014 ) , day of first mobilisation ( Day 1 , range 0 - 2 , vs. Day 2 , range 1 - 4 , p=0.001 ) , and rate of Symptomatic bacturia ( 16 % vs. 52 % , p<0.01 ) were all significantly better with immediate catheter removal . CONCLUSIONS After vaginal surgery for pelvic organ prolapse , the majority of patients do not require extended catheterisation . Early removal of a catheter reduces urinary tract infection and significantly decreases hospital stay . Such a policy should result in improved patient satisfaction and reduced hospital costs In a prospect i ve study the results of postoperative urinary discharge by suprapubic catheterisation ( SC )  are compared with those of transurethral catheterisation ( TC ) in a r and omised collective of gynaecological patients after vaginal hysterectomy with front ( resp . front and back ) plastic . During November 1979 and September 1980 157 patients were examined , 88 patients by suprapubic catheterisation and 69 by transurethral catheterisation , with r and om distribution . Additionally , 430 other patients with suprapubic aspiration after vaginal hysterectomy with front and /or back plastic performed between September 1980 and October 1982 were examined retrospectively especially under the aspect of possible complications . The advantages of suprapubic urinary discharge are shown in the significantly reduced rate of primary infections . 20.5 per cent of infections are opposed to 67.1 per cent in the comparative group with TC . Spontaneous miction was possible in the SC group two days earlier than in the group of TC ( 5.2 days opposed to 7.35 days ) . Additional drug treatment for restitution of the bladder function was more often necessary for patients with TC , although the results with 43.5 per cent against 29.5 per cent in the SC collective are not significant . The number of renewed catheterisations after removal of the catheter was higher by 27 per cent in the group of patients with SC . Subjective complaints were stated by patients with TC in 66.7 per cent against 18.2 per cent of women with SC . This result is significant . In the TC collective there were significantly more patients with leucocyturia ( 88.5 per cent against 48.7 per cent ) . Antibiotic treatment of an urinary tract infection with typical symptoms was necessary in 35.8 per cent for patients with TC and in 14.1 per cent for women with SC . ( ABSTRACT TRUNCATED AT 250 WORDS We surveyed the extensive literature regarding the development , therapy and prevention of  catheter-associated urinary tract infections ( UTIs ) .  We systematic ally search ed for meta-analyses of r and omised controlled trials available in Medline giving preference to the Cochrane Central Register of Controlled Trials and also considered other relevant publications , rating them on the basis of their quality . The studies ’ recommendations , rated according to a modification of the US Department of Health and Human Services ( 1992 ) , give a close-to- evidence based guideline for all medical disciplines , with special emphasis on urology where catheter care is an important issue . The survey found that the urinary tract is the commonest source of nosocomial infection , particularly when the bladder is catheterised ( IIa ) . Most catheter-associated UTIs are derived from the patient ’s own colonic flora ( IIb ) and the catheter predisposes to UTI in several ways . The most important risk factor for the development of catheter-associated bacteriuria is the duration of catheterisation ( IIa ) . Most episodes of short-term catheter-associated bacteriuria are asymptomatic and are caused by a single organism ( IIa ) . Further organisms tend to be acquired by patients catheterised for more than 30 days . The clinician should be aware of two priorities : the catheter system should remain closed and the duration of catheterisation should be minimal ( A ) . While the catheter is in place , systemic antimicrobial treatment of asymptomatic catheter-associated bacteriuria is not recommended ( A ) , except for some special cases . Routine urine culture in an asymptomatic catheterised patient is also not recommended ( C ) because treatment is in general not necessary . Antibiotic treatment is recommended only for symptomatic infection ( B ) . Long-term antibiotic suppressive therapy is not effective ( A ) . Antibiotic irrigation of the catheter and bladder is of no advantage ( A ) . Routine urine cultures are not recommended if the catheter is draining properly ( C ) . A minority of patients can be managed with the use of the non-return ( flip ) valve catheter , avoiding the closed drainage bag . Such patients may exchange the convenience of on-dem and drainage with an increased risk of infection .  Patients with urethral catheters in place for 10 years or more should be screened annually for bladder cancer ( C ) . Clinicians should always consider alternatives to indwelling urethral catheters that are less prone to causing symptomatic infection . In appropriate patients , suprapubic catheters , condom drainage systems and intermittent catheterisation are each preferable to indwelling urethral catheterisation ( B ) Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Abstract . Ninety‐two patients with preoperative sterile urine undergoing colposuspension or vaginal repair operation for stress urinary incontinence and /or genital descensus were r and omized to either suprapubic or transurethral postoperative catheter drainage .  The prevalence of significant bac‐teriuria on the fifth postoperative day was statistically significantly lower when using suprapubic catheter ( 20.8 % ) than with transurethral catheter drainage ( 45.5 % ) . This applied especially to colposuspension . The rate of postoperatively impaired bladder emptying also tended to be reduced when using suprapubic catheter . At follow‐up after one year , postoperative bacteriuria was closely correlated to increased rates of both clinical cystitis and asymptomatic significant bacteriuria . Thus it is recommended to use suprapubic bladder drainage not only after colposuspension but also after vaginal repair in an effort to avoid an increased risk of urinary infections Introduction and hypothesisDifferent forms of urinary drainage are applied after  anterior colporrhaphy . Suprapubic urinary catheter ( SUC ) and indwelling urinary catheter ( IUC ) for 2 to 96 h are preferred . If there is no difference in symptomatic urinary tract infection ( SUTI ) or complications between IUCs for 96 and 24 h , the latter will be considered sufficient . If IUCs have no higher rate of infections or complications compared to SUC for 96 h , the former could be considered sufficient . Methods It was a three-arm prospect i ve , r and omized study including 257 patients . The three arms were : IUCs for 24 h , IUCs for 96 h , and SUCs for 96 h. Results We found no significant difference in SUTIs between all three groups . Although the SUC arm showed no SUTIs , a significant higher rate of complications was seen . Conclusion The optimal bladder catheter after anterior colporrhaphy was , in our trial , the IUC for 24 A controversy exists concerning the most appropriate method of bladder drainage after vaginal hysterectomy and anterior-posterior repair . The present study compares the use of the Foley catheter and the suprapubic tube following these operations . One hundred and fifty suitable c and i date s were selected , with 75 using each system . The results showed that the suprapubic group had one-third the rate { 12 % vs 38 % ) of significant bacteriuria when compared to the Foley group at the time the instruments were removed on the fourth postoperative day . In addition the Foley group also had a significant increase in the number of positive urine cultures 6 weeks after the operation ( 10 % vs 2 % ) , a higher incidence of prolonged hospitalization ( greater than 6 days ) , and a more frequent use of bladder analgesics ( 69 % vs 41 % ) . Other advantages in the use of suprapubic tubes after vaginal surgery appeared to be ease of care by ward personnel , greater patient comfort , and a reduced incidence of severe complications . An additional finding of this study was related to the increase of significant bacteriuria in patients receiving cold knife conization prior to hysterectomy . This factor appeared to be constant regardless of the drainage system used although a greater number of cases were found in the Foley group OBJECTIVE To determine the potential benefits of ISC ( intermittent self-catheterisation ) over SPC ( supra-pubic catheterisation ) in the post-operative bladder care of women following radical hysterectomy . METHODS A prospect i ve r and omised controlled trial of women treated by radical hysterectomy for early stage cervical cancer . RESULTS . : 40 women were recruited to the study , 21 to ISC and 19 to SPC . All patients r and omised to ISC were able to learn the technique of ISC satisfactorily following a period of pre-operative training . The day 3 and day 5 positive CSU ( catheter specimen of urine ) rate was significantly higher in the ISC group ( 42 % and 63 % ) compared to the SPC group ( 6 % and 18 % ) , P = 0.05 and P = 0.004 , respectively ) . Eight of 17 patients r and omised to SPC ( 47 % ) documented having symptoms/problems arising from the SPC site of which 4 ( 23 % ) were shown to have a positive wound swab . There was no significant difference in length of period for bladder care between the two groups , P = 0.83 . However , there were significant differences in patient acceptability ( P = 0.009 ) , freedom to lead a normal life ( P = 0.000 ) , disturbance at night ( P = 0.006 ) and patient anxiety/embarrassment ( P = 0.005 ) between the two groups . CONCLUSIONS Patients are able to learn the technique of ISC without difficulty . Despite a greater urinary tract infection rate , the high incidence of SPC site problems can be avoided by use of ISC . The technique of ISC was seen to be more acceptable to patients allowing fewer disturbances at night , greater freedom to lead a normal life during the day and less anxiety/embarrassment compared to SPC In a prospect i ve r and omized study comprising 90 women undergoing vaginal plastic surgery , suprapubic and transurethral catheter drainage of the bladder were compared regarding urinary tract infection and asymptomatic bacteriuria . No statistically significant differences were found . The mean duration of catheterization  was 4.9 days for suprapubic vs 3.3 days for transurethral catheter patients . Postoperative urinary tract infection was diagnosed in 23.7 % of patients with suprapubic and in 27.5 % of patients with transurethral catheters .  Asymptomatic bacteriuria at catheter removal was found in 21.0 % of suprapubic and in 12.5 % of transurethral catheter patients . More mechanical complications were seen with SPCsthan with TUCs . It is concluded that the two methods involve similar risks of infectious complications but that SPCs have a higher rate of mechanical complications OBJECTIVE To compare the use of intermittent urethral catheterization with indwelling suprapubic catheterization in women undergoing surgery for urodynamic stress incontinence or uterovaginal prolapse . DESIGN R and omized controlled trial . SETTING Tertiary referral urogynaecology unit . POPULATION Women undergoing surgery for pelvic organ prolapse and /or stress urinary incontinence . METHODS Women were r and omized into one of two groups . Group 1 had bladder drainage using a suprapubic catheter inserted in theatre . The catheter was left on free drainage for 48 hours post-operatively before clamping . Group 2 was catheterized intermittently post-operatively . MAIN OUTCOME MEASURES Length of post-operative 
    Output:
    
No difference was found in other aspects ( complication rate and catheter-related pain ) among the three drainage routes .
Conclusions This meta- analysis suggested that suprapubic drainage was superior to indwelling urethral catheterization in reduction of asymptomatic bacteriuria and rate of recatheterization but was associated with higher rate of hematuria .
Intermittent catheterization was associated with a reduction in symptomatic UTI compared with indwelling urinary catheterization .