Patients with early-stage cervical cancer may have an increased risk of developing catheter-associated urinary tract infections following radical hysterectomies if they had a history of smoking or used catheters for more than 7 days postsurgery, according to a new study by Mercadel et al in the American Journal of Obstetrics & Gynecology. The new findings may have implications for patients with cervical cancer, some uterine and ovarian cancers, or any gynecologic tumors requiring radical hysterectomies.
Background
A radical hysterectomy is a standard treatment option for patients with early-stage cervical cancer—which is the second-leading cause of cancer-related mortality among female patients aged 20 and 39 years.
The procedure involves surgically removing the uterus, cervix, and upper part of the vagina and has the potential for significant adverse events postsurgery such as voiding dysfunction—which can cause patients difficulty emptying their bladders. Catheterization is a standard step taken to manage this complication.
However, catheter-associated urinary tract infections are among the most common complications after surgeries for gynecological malignancies and can lower the quality of life and recovery for patients.
Although smoking is generally associated with an increased risk of infection, this is the first study to identify it specifically as a risk factor for developing catheter-associated urinary tract infections. Notably, other patients identified in the study with suppressed immune systems did not have a higher rate of infection, suggesting other factors specific to smokers may contribute to the elevated risk.
Study Methods and Results
In the new study, researchers identified the rate of catheter-associated urinary tract infections and risk factors among 160 patients who had radical hysterectomies for early-stage cervical cancer from 2004 to 2020 using institutional gynecologic oncology surgical and tumor databases. They excluded patients with insufficient follow-up or records of catheter use, a urinary tract injury, or presurgical chemoradiation.
The researchers discovered that 12.5% (n = 20/160) of the patients had developed catheter-associated urinary tract infections.
Using statistical analysis to identify independent risk factors, the researchers then uncovered that current smokers and patients who had used a catheter for more than 7 days had a significantly higher rate of infection.
“This study identified factors—smoking cessation and early removal of a Foley catheter—as modifiable practice patterns that physicians can use to mitigate catheter-induced [urinary tract infections],” explained senior study author Jayanthi Lea, MD, the Patricia Duniven Fletcher Distinguished Professor of Gynecological Oncology, Professor of Obstetrics and Gynecology, and Chief of the Division of Gynecologic Oncology at the University of Texas Southwestern Medical Center; as well as Disease Oriented Team Leader for Gynecologic Oncology at the Harold C. Simmons Comprehensive Cancer Center.
Conclusions
Despite being a standard practice for managing urinary tract dysfunction, there is no consensus on the ideal duration for catheterization after patients undergo radical hysterectomies. The researchers recommend catheter removal within 7 days postsurgery and smoking cessation interventions before surgery to reduce the risk of infection.
“Urinary tract dysfunction is one of the most common complications after radical hysterectomy, and prolonged catheterization has previously been defined as a significant risk factor for catheter-associated urinary tract infections. This study provides concrete guidance on a practice that was previously undefined,” concluded Dr. Lea.
Disclosure: The research in this study was partially funded by Dr. Lea’s Patricia Duniven Fletcher Distinguished Professorship in Gynecological Oncology. For full disclosures of the study authors, visit ajog.org.
