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.

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 0.09-2.69). 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.