Urinary catheterization in gynecological surgery: When should it be removed?

  • Adly N.A. Fattah Department of Obstetric and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Budi I. Santoso Department of Obstetric and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Abstract viewed: 2597 times
PDF downloaded: 916 times


Background: The aim of this study was to determine the most appropriate time for urinary catheter removal following a gynecological surgery.

Methods: Critical appraisal of clinical trial articles were conducted. It was aimed to answer our clinical question whether 24-hour postoperative urinary catheter removal is superior compared to other durations in avoiding postoperative urinary retention (PUR) and urinary tract infection (UTI). The search was conducted on the Cochrane Library® and PubMed® using keywords âpostoperative urinary retentionâ, âpostoperative catheterizationâ and âurinary retention AND catheterizationâ. Reference lists of relevant articles were searched for other possibly relevant trials.

Results: Seven articles were available as full text, then appraisals of six prospective RCTs involving 846 women underwent hysterectomy and vaginal prolapse surgery were performed finding at the re-catheterization and UTI rate. Subjects in earlier-removal groups were 3 to 4 times more likely to have re-catheterization (OR = 3.10-4.0) compared to later-removal groups, while they who have it removed on 5th day were 14 times more likely to develop UTI compared with immediate group (OR = 14.786, 95% CI 3.187- 68.595).

Conclusion: The 24-hour catheterization policy in hysterectomy and vaginal prolapse surgery remains most appropriate although associated with an increased risk of re-catheterization. The removal of catheter before 24 hour (6 or 12 hour) could be considered to be used as one of interventions in further RCT(s) to find out the best duration which would result in lowest incidence in both of UTI and  PUR. (Med J Indones. 2013;22:183-8. doi: 10.13181/mji.v22i3.589)

Keywords: Catheter, hysterectomy, prolapse, urinary tract infection


  1. Kamilya G, Seal SL, Mukherji J, Bhattacharyya SK, Hazra A. A randomized controlled trial comparing short versus long-term catheterization after uncomplicated vaginal prolapse surgery. J Obstet Gynaecol Res. 2010;36(1):154-8. http://dx.doi.org/10.1111/j.1447-0756.2009.01096.

  2. Schiøtz HA, Tanbo TG. Postoperative voiding, bacteriuria and urinary tract infection with Foley catheterization after gynecological surgery. Acta Obstet Gynecol Scand. 2006;85(4):476-81. http://dx.doi.org/10.1080/00016340500409877

  3. Wyman A. What time of day should a urethral catheter be removed? J R Soc Med. 1987;80(12):755-6.

  4. Weinberger MW, Ostergard DR. Postoperative catheterization, urinary retention, and permanent voiding dusfunction after polytetrafluoroethylene suburethral sling placement. Obstet Gynecol. 1996;87(1):50-4. http://dx.doi.org/10.1016/0029-7844(95)00347-9

  5. Beadnell SW, Connaughton B, Farhood VW. Management of postoperative urinary retention. J Oral Maxillofac Surg. 1989;47(12):1307-10. http://dx.doi.org/10.1016/0278-2391(89)90730-1

  6. Lukasse M, Cederkvist HR, Rosseland LA. Reliability of an automatic ultrasound system for detecting postpartum urinary retention after vaginal birth. Acta Obstet Gynecol Scand. 2007;86(10):1251-5. http://dx.doi.org/10.1080/00016340701621478

  7. Darrah DM, Griebling TL, Silverstein JH. Postoperative urinary retention. Anesthesiol Clin. 2009;27(3):465-84. http://dx.doi.org/10.1016/j.anclin.2009.07.010

  8. Dobbs SP, Jackson SR, Wilson AM, Maplethorpe RP, Hammond RH. A prospective, randomized trial comparing continuous bladder drainage with catheterization at abdominal hysterectomy. Brit J Urol. 1997;80(4):554-6. http://dx.doi.org/10.1046/j.1464-410X.1997.t01-1-00376.x

  9. Hakvoort RA, Elberink R, Vollebregt A, Ploeg T, Emanuel MH. How long should urinary bladder catheterisation be continued after vaginal prolapse surgery? A randomised controlled trial comparing short term versus long term catheterisation after vaginal prolapse surgery. BJOG. 2004;111(8):828-30. http://dx.doi.org/10.1111/j.1471-0528.2004.00181.

  10. Tammela T, Kontturi M, Käär K, Lukkarinen O. Intravesical prostaglandin F2 for promoting bladder emptying after surgery for female stress incontinence. Brit J Urol. 1987;60(1):43-6.

  11. Petros JG, Rimm EB, Robillard RJ, Argy O. Factors influencing postoperative urinary retention in patients undergoing elective inguinal herniorrhaphy. Am J Surg. 1991;161(4):431-3. http://dx.doi.org/10.1016/0002-9610(91)91105-R

  12. Weemhoff M, Wassen M, Korsten L, Serroyen J, Kampschöer P, Roumen F. Postoperative catheterization after anterior colporrhaphy: 2 versus 5 days. A multicentre randomized controlled trial. Int Urogynecol J. 2011;22(4):477-83.

  13. Glavind K, Mørup L, Madsen H, Glavind J. A prospective, randomised, controlled trial comparing 3 hour and 24 hour postoperative removal of bladder catheter and vaginal pack following vaginal prolapse surgery. Acta Obstet Gynecol Scand. 2007;86(9):1122-5.

  14. Chai J, Pun TC. A prospective randomized trial to compare immediate and 24-hour delayed catheter removal following total abdominal hysterectomy. Acta Obstet Gynecol Scand. 2011;90(5):478-82. http://dx.doi.org/10.1111/j.1600-0412.2011.01104.x

  15. Phipps, S, Lim YM, McClinton S, Barry C, Rane A, N’Dow JMO. Short term urinary catheter policies following urogenital surgery in adults. Cochrane Database of Syst Rev. 2006;2:CD004374.

  16. Alessandri F, Mistrangelo E, Lijoi D, Ferrero S, Ragni N. A prospective, randomized trial comparing immediate versus delayed catheter removal following hysterectomy. Acta Obstet Gynecol Scand. 2006;85(6):716-20. http://dx.doi.org/10.1080/00016340600606976

  17. Niël-Weise BS, van den Broek PJ. Urinary catheter policies for short-term bladder drainage in adults. Cochrane Database Syst Rev. 2005;3:CD004203

  18. Makela M, Witt K. How to read a paper: critical appraisal of studies for application in healthcare. Singapore Med J. 2005;46(3):108-14.

  19. Abdullah M, Firmansyah MA. Critical appraisal on journal of clinical trials. Acta Med Indones. 2012;44(4):337-43.

  20. Sekhavat L, Farajkhoda T, Davar R. The effect of early removal of indwelling urinary catheter on postoperative urinary complications in anterior colporrhaphy surgery. Aust N Z J Obstet Gynaecol. 2008;48(3):348-52. http://dx.doi.org/10.1111/j.1479-828X.2008.00842.

  21. Dunn TS, Shlay J, Forshner D.Are in-dwelling catheters necessary for 24 hours after hysterectomy? Am J Obstet Gynecol. 2003;189(2):435-7. http://dx.doi.org/10.1067/S0002-9378(03)00496-4

  22. Griffiths R, Fernandez R. Strategies for the removal of short-term indwelling urethral catheters in adults. Cochrane Database Syst Rev. 2007;(2):CD004011.

How to Cite
Fattah AN, Santoso BI. Urinary catheterization in gynecological surgery: When should it be removed?. Med J Indones [Internet]. 2013Aug.23 [cited 2024May29];22(3):183-8. Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/589
Case Report/Series