The effect of the timing of catheter removal on postoperative urinary continence after radical prostatectomy: a systematic review and meta-analysis.

Background: The optimal length of postoperative catheterisation time after radical prostatectomy remains to be controversial. We performed a meta-analysis to explore the impact of catheter removal time on urinary continence after radical prostatectomy (RP).

Methods: The MEDLINE, Embase, Cochrane Library, and Web of Science databases were searched to identify eligible studies published before June 2025. The inverse variance method with random-effects modeling was used to calculate summary odds ratios (ORs) and their associated 95% confidence intervals (CIs).

Results: Fifteen studies comprising 4,159 patients who underwent RP matched our eligibility criteria. Early catheter removal was associated with an increased likelihood of urinary retention (OR = 2.20, 95% CI: 1.22-3.95) in the postoperative day (POD) 2 group compared to more than POD 2 days group. However, this significant difference was not observed in patients with POD 3 (vs POD > 3, OR = 1.37, 95% CI: 0.37-5.09), patients with POD 4 (vs POD > 4, OR = 4.41, 95% CI: 0.88-22.18), and patients with POD 7 (vs POD > 7, OR = 6.49, 95% CI: 0.80-52.83). Moreover, early removal of the catheter was not associated with an increased risk of urinary incontinence (OR = 1.25, 95% CI: 0.58-2.68), anastomotic leakage (OR = 1.22, 95% CI: 0.76-1.96), vesical neck stenosis (OR = 0.73, 95% CI: 0.09-5.83) compared to the regular group. The findings are robust, as indicated by sensitivity and meta-regression analyses.

Conclusions: Early catheter removal seems feasible, but one should be aware of the increased risk of urinary retention, especially in patients of POD 2. Moreover, it seems to be safe in terms of urinary incontinence, anastomotic leakage, and vesical neck stenosis. We hope that our findings will help to guide the standardised management of catheter removal after RP, and early catheter-free discharge after RP may provide relevant clinical benefits for these patients.