الفهرس 
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Abstract
Catheterization of urinary bladder prior to cesarean section is a long-standing practice that has been continued for a long time without being subjected to critical evaluation (Senanayake, 2005).
The main idea for catheterization is the belief that empty bladder is at less risk of damage during surgery than a distended one. A distended bladder is also expected to interfere with exposure of surgical field which makes surgery more difficult (Senanayake, 2005).
The main disadvantage of catheterization is the increased risk of urinary tract infection (UTI) (Schwartz, 1999).
Although the dictum that, the bladder should be catheterized in order to protect it from intraoperative injury, it could be said that a slightly filled bladder may be better demarcated, more easily identified and less vulnerable to injury. Even in the case of accidental cystotomy, urine will flow out from site of injury drawing attention to the damage. This would be more reliable and an earlier indicator of cystotomy than the other indirect methods such as postoperative haematuria (Senanayake, 2005).
This study compares between the rates of UTI in elective cesarean sections with and without urethral catheterization. This study also detects the effect of doing elective cesarean section without urethral catheterization on the surgical ease, intraoperative problems, bladder injuries and postoperative urine retention.
This study as prospective randomized controlled trial carried out on 280 patients with written consent, undergoing elective cesarean sections that were divided into two equal groups:
Group Ι: It included 140 women who had undergone elective cesarean section without urethral catheterization.
Group ΙΙ: It included 140 women who had undergone elective cesarean section with urethral catheterization.
Both groups preoperatively were subjected to:
1. History.
2. Examination.
3. Investigation (urine analysis and culture sensitivity if needed).
All patients included in this trial were subjected to primary cesarean section by the ordinary classic technique after general anesthesia.
Both groups postoperatively were subjected to:
• Routine analgesia, fluids and nursing.
• Evaluation of possible complications by: symptoms, signs and investigations (urine analysis and culture sensitivity if needed).
In this study there was no statistically significant difference could be detected between both studied groups as regard general demographic data.
There was no statistically significant difference between both studied groups as regard the operative time.
During surgery the bladder filling level above the lower cut edge of the sheath varied between less than three cm in 70% of cases and more than three cm in only 30% of cases, however the bladder was entirely covered by Doyen’s retractor in 100% of cases so it did not interfere with the peritoneal entry and also it was protected. Even at the end of surgery, the bladder did not distend to a level that interfered with closure.
The incidence of urinary tract infection diagnosed by urine analysis and culture and sensitivity test was significantly lower in group I (0.7% in group I versus 6.4% in Group II) ( p < 0.05).
There was significant reduction in the time of ambulation (from the end of cesarean section till first ambulation) in group Ι.
Reduction in the time of hospital stay was detected in group I whose patients had undergone elective cesarean section without urethral catheterization.
In conclusion: the results of this randomized controlled trial demonstrated reduction in the incidence of UTI, reduction in the hospital stay and early ambulation; when cesarean delivery was done without application of routine indwelling urinary catheter.