Is it okay to remove a Foley (urinary) catheter from a patient who has had a right double ureteral stent placed?

Removing a Foley Catheter After Right Double Ureteral Stent Placement

Yes, it is safe and recommended to remove a Foley catheter from a patient who has had a right double ureteral stent placed, and the catheter should be removed as early as possible if no clinical indication exists for continued catheterization.

Rationale for Early Foley Catheter Removal

• According to the Enhanced Recovery After Surgery (ERAS) Society guidelines, urinary catheter use should be evaluated daily, and the catheter should be removed as early as possible to reduce complications 1.
• The 2022 ERAS Society recommendations specifically state that "Foleys catheter should be removed in the majority of cases within 24 h after surgery and individualized in patients with high risk of retention" 1.
• The presence of a double ureteral stent is not a contraindication to Foley catheter removal, as these serve different purposes:
  • Double J stents maintain patency of the ureter
  • Foley catheters drain the bladder

Assessment Before Removal

Before removing the Foley catheter:

1. Confirm the purpose of the double stent placement - ensure the stent is functioning properly
2. Verify no contraindications exist for Foley removal:
   • Acute urinary retention
   • Need for strict output monitoring in unstable patients
   • Recent urological surgery requiring bladder decompression
3. Check for proper stent positioning - confirm via imaging if uncertain

Removal Procedure

1. Assess the patient's condition and ensure they are stable
2. Explain the procedure to the patient
3. Deflate the balloon completely
4. Remove the catheter using gentle, steady traction
5. Monitor the patient for successful voiding after removal

Post-Removal Monitoring

• Monitor for first void within 6-8 hours after catheter removal
• Assess for signs of urinary retention:
  • Inability to void
  • Bladder distention
  • Lower abdominal discomfort
• Check for signs of infection:
  • Fever
  • Cloudy/foul-smelling urine
  • Increased pain or discomfort

Special Considerations with Double Stents

• The presence of a double J stent may cause some bladder irritation and urgency, which is normal 2
• Patients should be informed that mild hematuria or discomfort may occur due to the stent, not from Foley removal
• Unlike some cases where stents are tied to Foley catheters for removal 2, standard double J stents remain in place when the Foley is removed
• Double J stents typically remain in place for 2-4 weeks and require separate removal, usually via cystoscopy

Potential Complications to Monitor

• Urinary retention (may require reinsertion of catheter)
• Urinary tract infection
• Bladder spasms related to stent irritation
• Hematuria

Common Pitfalls to Avoid

1. Prolonged catheterization - increases risk of catheter-associated urinary tract infections
2. Removing stent with Foley - unless specifically designed for this purpose, double J stents are not removed with the Foley catheter
3. Ignoring post-void residuals - consider bladder scan if retention is suspected
4. Failing to document stent details - ensure stent removal plan is clearly documented to prevent forgotten stents 3

The evidence strongly supports early removal of Foley catheters to reduce infection risk and improve patient comfort, even in patients with ureteral stents 1, 4. This practice aligns with current guidelines for reducing catheter-associated complications and enhancing recovery after procedures.