Risks associated with early postoperative urinary catheter removal during epidural analgesia: An updated systematic review and meta-analysis.

Abstract

Background and aims: The efficacy and safety of early urinary catheter removal during epidural analgesia after surgery remain unclear. The primary objective of this review was whether early removal of urinary catheters within 48 hours after surgery, regardless of ongoing epidural analgesia, affects the incidence of postoperative urinary retention (POUR) in patients undergoing surgery under epidural analgesia, compared to late removal.

Methods: We conducted a systematic search of MEDLINE, Embase, and CENTRAL in November 2024 to identify randomised controlled trials (RCTs) assessing the impact of early catheter removal. A random-effects meta-analysis was performed, and the certainty of the evidence (CoE) was evaluated using the GRADE approach. The study protocol was registered in PROSPERO (CRD42024612683).

Results: A total of six RCTs involving 707 patients were included. Early urinary catheter removal was associated with an increased risk of postoperative urinary retention compared to late removal (risk difference [RD]: 0.09; 95% confidence interval [CI]: 0.01, 0.17; low CoE). However, no significant differences were observed in the incidence of urinary tract infections (RD: -0.03; 95% CI: -0.09, 0.03; very low CoE) or the length of hospital stay (mean difference: -1.0 day; 95% CI: -3.0, 1.0; very low CoE) between the groups.

Conclusion: Early removal of urinary catheters during epidural analgesia may increase the POUR without significantly impacting the incidence of urinary tract infections or the length of hospital stay. These findings underscore the importance of carefully weighing the risks and benefits when considering early catheter removal in clinical practice.