Foley catheterization in the postoperative patient

Abstract

Objective: Foley catheters are used routinely in gynecologic surgery. We wanted to address the issue of whether this was necessary and affected patient outcome. The question asked in this study is, “Does early removal of the Foley catheter after pelvic surgery affect recatheterization, febrile morbidity, symptomatic urinary tract infections, and patient comfort?”Methods: This is a prospective randomized clinical trial conducted at a university teaching hospital on all patients undergoing hysterectomy or cesarean delivery, not requiring bladder suspension or strict fluid management. The Foley catheter was either removed immediately, postoperatively, or on the first postoperative day. The variables studied were recatheterization, febrile morbidity, symptomatic urinary tract infections, and pain.Results: Seventy-eight patients were included in this trial. Twenty-nine patients underwent a cesarean delivery, 38 patients underwent a vaginal hysterectomy, and 11 patients underwent abdominal hysterectomy. The outcome for these patients are as follows: in all cases only five patients had a fever, P value was nonsignificant, two patients had urinary tract infections with a P value that is nonsignificant, and recatheterization occurred in five patients (P value of 0.17). The level of pain was measured using a standardized pain scale, described as mild, moderate, or severe. Evaluating all cases, n = 78 (P = 0.001), patients had significantly less pain with early removal of the Foley catheter. The same was true when done for all cesarean hysterectomies; the pain was significantly less (0.001) in the early removal group. There were no patients with severe pain in the early removal group.Conclusions: Patients who had the Foley catheter removed immediately following surgery had no increase in fever, urinary tract infections, or incidence of recatheterization. There was also significantly less pain in the early removal group. In some patients, the Foley catheter is not required in the postoperative period and patients report less discomfort.