From the Guidelines
A Foley catheter should be removed within 24 hours after stent placement for kidney stones in the majority of cases, with individualized consideration for patients at high risk of retention. This approach is supported by the Enhanced Recovery After Surgery (ERAS) Society recommendations, as outlined in the 2022 guidelines for perioperative care in elective abdominal and pelvic surgery at primary and secondary hospitals in low-middle-income countries (LMICs) 1. The decision to remove the catheter is based on several factors, including:
- The complexity of the procedure
- Presence of urinary tract infection
- Amount of bleeding
- Patient's ability to urinate independently Key considerations before removal include:
- The urine should be relatively clear without significant bleeding
- Patients should be monitored for their ability to urinate after catheter removal
- Adequate pain control with medications like NSAIDs or opioids as needed is important during this period
- Increased fluid intake (2-3 liters daily) should be encouraged to help flush the urinary system and prevent clot formation. According to the ERAS Society recommendation 1, individualized assessment is crucial for patients with a high risk of retention, ensuring that the catheter removal is tailored to their specific needs.
From the Research
Removal of Foley Catheter after Placing a Stent for Kidney Stone
- The optimal time for removing a Foley catheter after placing a stent for kidney stone is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, a study on kidney transplant patients found that removing the Double-J stent with the Foley catheter around the 8th post-operative day was a safe maneuver regarding major urological complications, reduced pain, and eliminated the cost of cystoscopy 5.
- Another study on alpha-blockers as medical expulsive therapy for ureteral stones found that alpha-blockers likely increase stone clearance but probably also slightly increase the risk of major adverse events 6.
- The use of alpha-blockers prior to removal of a catheter for acute urinary retention in adult men was found to increase the success rates of trial without catheter, with low adverse effect rates 2, 3.
- A study on the efficacy and safety of alpha-blockers for kidney stones in adults found that alpha-blockers are beneficial without lithotripsy for ureteral stones 5 to 10 mm, and beneficial post-lithotripsy for renal or ureteral stones >10 mm 4.
Key Findings
- Alpha-blockers may increase stone clearance and reduce the risk of recurrent urinary retention 2, 3, 4, 6.
- The optimal duration of alpha-blocker treatment after successful trial without catheter remains unknown 2, 3.
- The use of alpha-blockers prior to removal of a catheter for acute urinary retention in adult men may reduce the incidence of acute urinary retention 2, 3.