From the Guidelines
I do not recommend placing a Foley catheter for routine rhinoplasty procedures. Rhinoplasty is typically a relatively short procedure (1-3 hours) that does not directly affect the urinary system, making an indwelling catheter unnecessary in most cases. Patients can empty their bladder immediately before surgery, which is usually sufficient for the duration of the procedure. Foley catheters carry risks including urinary tract infections, urethral trauma, patient discomfort, and potential for longer hospital stays. They should only be considered in specific circumstances such as very lengthy procedures (over 4-5 hours), cases combined with other major surgeries, patients with pre-existing urinary retention issues, or when significant fluid administration is anticipated. For standard rhinoplasty, the risks of catheterization outweigh the benefits, and most patients can resume normal urination shortly after recovery from anesthesia. The anesthesiologist can manage IV fluids appropriately to minimize bladder filling during the procedure. According to the most recent guidelines, the use of indwelling catheters should be avoided due to the risk of urinary tract infections 1.
Some key points to consider when deciding whether to place a Foley catheter include:
- The duration of the procedure: Rhinoplasty is typically short, and a Foley catheter is not necessary.
- The patient's medical history: Patients with pre-existing urinary retention issues may require a Foley catheter.
- The anticipated fluid administration: Significant fluid administration may require a Foley catheter.
- The potential risks: Foley catheters carry risks including urinary tract infections, urethral trauma, and patient discomfort.
In general, Foley catheters should only be used when medically necessary, and their use should be minimized to reduce the risk of complications 1. The anesthesiologist and surgical team should work together to determine the best approach for each individual patient.
It's also important to note that the majority of cases do not require a Foley catheter, and it's recommended to remove the catheter within 24 hours after surgery, individualizing the approach for patients with high risk of retention 1.
Overall, the risks associated with Foley catheter placement outweigh the benefits for routine rhinoplasty procedures, and alternative approaches should be considered to minimize the risk of complications.
From the Research
Placement of Foley Catheter for Rhinoplasty
- There is no direct evidence in the provided studies that specifically addresses the placement of a Foley catheter for rhinoplasty 2, 3, 4, 5, 6.
- However, studies on other surgical procedures suggest that the use of Foley catheters may not always be necessary and can be associated with complications such as urinary tract infections and genitourinary trauma 4, 5.
- The decision to place a Foley catheter may depend on various factors, including the type and duration of the surgery, the patient's overall health, and the risk of postoperative urinary retention 2, 6.
- Some studies recommend against routine placement of Foley catheters in certain surgical procedures, such as mastectomy with or without reconstruction, and suggest that patients can avoid Foley catheter placement without increased risk of urinary retention 4.
- In other cases, such as minimally invasive repair of pectus excavatum, the use of Foley catheters may be beneficial in reducing the risk of urinary retention, especially in patients with epidural pain control 5.