How long should a Foley catheter be left in place after repair of a pendular urethral injury?

Duration of Foley Catheterization After Pendular Urethral Injury Repair

After surgical repair of a pendular (anterior) urethral injury, a Foley catheter should be left in place for 2-3 weeks, with urethrography performed every two weeks until complete healing is confirmed. 1

Standard Catheterization Duration

• The standard duration for urethral catheter drainage following anterior urethral repair is 2-3 weeks. 1

• This timeframe allows adequate healing of the urethral anastomosis while minimizing complications from prolonged catheterization. 1

• A standard 14-16 Fr Foley catheter is appropriate for urinary drainage after repair. 2

Follow-Up Imaging Protocol

• Urethrography should be performed every two weeks until complete healing is documented. 1

• This imaging confirms urethral continuity and absence of extravasation before catheter removal. 1

• Ureteroscopy or urethrogram are the methods of choice for follow-up assessment of urethral injuries. 1

Clinical Context and Modifications

The 2-3 week timeframe applies specifically to uncomplicated penetrating lesions of the anterior urethra that undergo prompt direct surgical repair. 1

When Longer Catheterization May Be Needed:

• Large anatomic defects (>2-3 cm in bulbar urethra or >1.5 cm in penile urethra) that require marsupialisation and delayed reconstruction with graft or flap necessitate temporary suprapubic catheter placement instead, with interval urethroplasty at >3 months. 1

• Significant concurrent injuries may justify extended catheterization beyond the standard 2-3 weeks, though this should be based on the patient's overall clinical condition rather than routine practice. 1

• Complex repairs involving extensive tissue damage or tension on the anastomosis warrant consideration for prolonged drainage. 1

Important Caveats

• Suprapubic catheterization is not routinely necessary after straightforward anterior urethral repair; urethral catheterization alone has equivalent efficacy. 1

• Suprapubic drainage may be reserved for cases with associated perineal injuries or when urethral catheterization is contraindicated. 1

• Do not remove the catheter before confirming healing with urethrography, as premature removal risks urethral stricture formation or fistula development. 1

• If healing is not complete at 2-3 weeks, continue catheter drainage and repeat imaging at 2-week intervals until healing is confirmed. 1