A Randomized Controlled Study on the Impact of Early Urinary Catheter Removal on Postoperative Urinary Retention in Abdominal and Thoracic Surgery Patients with Thoracic Epidural Analgesia

Background: Thoracic epidural analgesia (TEA) is a key component of Enhanced Recovery After Surgery protocols for major abdominal and thoracic procedures. Despite its benefits for pain management, has been associated with an increased risk of postoperative urinary retention (POUR). Consequently, it is common practice to maintain a urinary catheter (UC) for the duration of TEA. This study aimed to evaluate the impact of early UC removal in patients receiving TEA through a randomized controlled trial. Methods: In this randomized controlled trial approved by the Rostock University Medical Center ethics board (AZ A2018-0220), patients scheduled for elective major abdominal or thoracic surgery with anticipated TEA within one year were enrolled. Participants were randomized into two groups: the early removal group (ERG), where the UC was removed within 48 hours post-surgery, and the standard group (SG), where the UC was retained until TEA discontinuation. POUR was defined as a residual urine volume of ≥400 mL measured by ultrasound, and catheter-associated urinary tract infections (CAUTI) were assessed. Results: Of the 99 patients initially enrolled, 81 patients were available for analysis. In the ERG (n = 43), the UC was removed within 48 hours, whereas in the SG (n = 38) the UC was maintained until TEA cessation. The incidence of POUR was similar between the groups, with one patient in each group (2.3% in ERG vs. 2.6% in SG, p = 1) requiring recatheterization. CAUTI developed in 4 patients (4.9%), all of whom were in the SG (10.5%), indicating a statistically significant association between the timing of UC removal and CAUTI incidence (p = 0.044). Conclusion: Our results suggest that early UC removal under TEA is safe and does not significantly increase the risk of POUR while reducing the incidence of CAUTIs. These findings support the feasibility of early UC removal in this patient population and may inform future guidelines on perioperative urinary catheter management in the context of TEA.