How long should a Foley catheter (Foley cath) be kept in place after a prostatectomy?

Duration of Foley Catheter After Prostatectomy

The Foley catheter should be removed 7-10 days after radical prostatectomy in most patients, with removal as early as 3-4 days being safe if cystography confirms no anastomotic leak. 1

Standard Catheter Duration

Remove the catheter between 7-14 days postoperatively, with 7-10 days being the optimal timeframe for most patients. 1

• After radical prostatectomy, the bladder is reconnected to the urethra and a catheter remains in place for a period generally ranging from 1 week to 2 weeks 1
• The traditional 14-day duration can be safely shortened to 7 days without increasing complication rates 2
• Removal at 7 days versus 14 days shows equivalent rates of short-term complications, continence outcomes, and no difference in urinary fistula, urinoma, or pelvic abscess formation 2

Early Removal Protocol (3-4 Days)

Early catheter removal on postoperative day 3-4 is safe and effective if cystography demonstrates no extravasation. 3, 4, 5

When Early Removal is Appropriate:

• Perform low-pressure cystography on postoperative day 3 or 4 to assess for anastomotic leak 3
• If no leak is visualized, the catheter can be safely removed 3, 4
• Early removal (days 2-4) after laparoscopic prostatectomy shows no increased risk of incontinence, stricture, or leak-related problems 4
• Approximately 72-85% of patients are candidates for early removal based on cystography findings 3, 4

Contraindications to Early Removal:

• Significant leak on cystogram or excessive suprapubic drainage (occurs in ~21% of patients) 3
• Extensive bladder neck reconstruction required during surgery 3
• Prolonged hospitalization due to ileus or other complications 3

Management Without Cystography

Catheter removal at 7-9 days without cystography is safe with appropriate patient selection. 2, 6

• Catheters can be removed in clinic 8-9 days after surgery without radiographic studies if there is no evidence of urine leak, pelvic hematoma, rectal injury, or severe obesity 6
• This approach shows no increased incidence of anastomotic stricture, retention, or incontinence compared to traditional management 6

Complication Rates and Management

Urinary Retention:

• Occurs in 3.6-10.4% of patients after early catheter removal 3, 4
• Managed by simple catheter reinsertion without need for cystoscopy 4
• Does not require return to operating room and resolves within 24 hours of re-catheterization 4

Anastomotic Stricture:

• Bladder neck contracture develops in 5-14% of men after prostatectomy 1
• Rate of stricture formation (8-9%) is not increased with early versus late catheter removal 2, 6

Major Complications:

• Serious complications (pelvic abscess, lymphocele requiring drainage) occur in <1% of cases regardless of catheter duration 3
• No difference in wound infection, pelvic abscess, or urinary fistula formation between early (7-day) and standard (14-day) removal 2

Continence Outcomes

Continence rates are equivalent regardless of catheter duration (early versus standard removal). 3, 4, 2

• At 6+ months follow-up, 89-93% of patients report excellent continence with early removal protocols 3, 4
• Most men are not continent at catheter removal but achieve continence within 12 months of surgery 1
• Pelvic floor muscle exercises should be offered immediately upon catheter removal to improve time-to-continence 1

Infection Prevention

Remove the catheter as soon as clinically appropriate to minimize infection risk. 1

• Use of a Foley catheter for more than 48 hours increases risk of urinary tract infection 1
• The main risk factor for catheter-associated infections is the length of time the device remains in place 7
• Do not routinely use prophylactic antibiotics throughout the catheter duration unless specifically indicated 7

Common Pitfalls to Avoid

• Do not routinely leave catheters for 14 days when 7-day removal is safe and appropriate - this unnecessarily increases infection risk without improving outcomes 2
• Do not remove the catheter earlier than recommended without cystographic confirmation of healing if attempting early (3-4 day) removal 3
• Do not attribute post-removal urinary retention to surgical failure - it occurs in up to 10% of patients and is easily managed with temporary re-catheterization 3, 4
• Ensure adequate patient selection for early removal - exclude patients with extensive bladder neck reconstruction, significant intraoperative complications, or evidence of leak 3, 6

Practical Algorithm

1. Days 3-4: Perform cystography if considering early removal

   • No leak → Remove catheter 3, 4
   • Leak present → Leave catheter, repeat cystography at day 7-10 3

2. Days 7-10: Standard removal timeframe

   • Remove catheter without cystography if uncomplicated postoperative course 2, 6
   • Consider cystography if concerns about healing 3

3. Day 14: Maximum duration for routine cases

   • Only extend beyond 14 days for documented non-healing or significant complications 7

4. Post-removal: Initiate pelvic floor muscle training immediately 1