Early Versus Delayed Removal of the Urethral Catheter After Percutaneous Nephrolithotomy: A Systematic Review of Safety, Feasibility and Impact on Enhanced Recovery

Tauheed Fareed*

Background: The optimal timing of urethral catheter removal following percutaneous nephrolithotomy (PCNL) remains undefined, with practices varying widely. Early removal may reduce catheter-associated complications and accelerate recovery, but concerns about urinary retention, clot obstruction, and nephrostomy site leakage persist.

Objective: To systematically evaluate the evidence on early urethral catheter removal (within 24 hours) versus delayed removal (beyond 24 hours) after PCNL, examining safety outcomes, patient comfort, and enhanced recovery endpoints.

Methods: A systematic search of PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science were conducted up to May 2026. Studies comparing early catheter removal (postoperative day 0–1) with delayed removal (postoperative day ≥2) in adult PCNL patients were included. Outcomes assessed were urinary retention, recatheterization rates, hematuria, nephrostomy site leakage, pain scores, catheter-associated urinary tract infection (CAUTI), and length of stay. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized trials and the Newcastle-Ottawa Scale for observational studies. Meta-analysis was performed where feasible using a random-effects model. The protocol was submitted to PROSPERO prior to data extraction and has now been registered (CRD4202461XXXX).

Results: Twelve studies (4 randomized controlled trials, 8 observational studies) involving 1,847 patients met inclusion criteria. Early catheter removal did not increase the risk of urinary retention (RR 0.89, 95% CI 0.52–1.52, p=0.67) or recatheterization (RR 1.12, 95% CI 0.65–1.93, p=0.68). A sensitivity analysis restricted to the four RCTs confirmed these findings for both urinary retention (RR 0.94, 95% CI 0.38–2.31, p=0.89) and recatheterization (RR 1.05, 95% CI 0.42–2.62, p=0.92). CAUTI rates were significantly lower in the early removal group (RR 0.31, 95% CI 0.16–0.59, p<0.001). Pain scores were consistently and significantly lower after early removal (standardized mean difference -1.25, 95% CI -1.78 to -0.72, p<0.001). Nephrostomy site leakage did not differ between groups (RR 1.05, 95% CI 0.68–1.62, p=0.83). Early removal was associated with earlier ambulation; length of stay showed a non-significant trend toward reduction (MD −0.4 days, 95% CI −0.9 to 0.1, p=0.13; I² = 62%) and a confirmed benefit cannot be claimed.

Conclusions: Early urethral catheter removal within 24 hours after uncomplicated PCNL is safe and does not increase the risk of urinary retention, clot retention, or nephrostomy leakage. It significantly reduces catheter-related pain and CAUTI rates while promoting earlier mobilization. Early removal should be incorporated into enhanced recovery protocols for PCNL.

Keywords:

Published on: Aug 3, 2026 Pages: 21-27

Full Text PDF Full Text HTML DOI: 10.17352/aur.000059
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