Background Indwelling urinary catheters (IDUCs) are associated with complications and early removal is therefore essential. Currently, it is unknown what the effect of a specific removal time is and what the consequences of this removal time are. Research question To present an overview of the available evidence to determine the effects of three postoperative IDUC removal times (after a certain number of hours, at a specific time of day and flexible removal time) on the development of complications in hospital. Methods PubMed, Medline, Embase, Emcare and Cochrane Central Register of Controlled Trials were searched till 6 June, 2021. Studies were included that described the effect of the removal time in relation to re‐catheterisation, urinary tract infections (UTIs), ambulation time, time of first voiding and hospital stay. The quality of the studies was assessed with the Newcastle‐Ottawa Scale and the Cochrane Effective Practice and Organisation of Care. A narrative descriptive analysis was performed. PRISMA guidelines were followed in reporting this review. Results Twenty studies were included from which 18 compared removal after a number of hours, 1 reported on a specific removal time and 1 reported on both topics. The results were contradicting regarding the hypothesis that later removal increases the incidence of UTIs. Earlier removal does not lead to a higher re‐catheterisation rate while immediate removal is beneficial for reducing the time to first ambulation and shortening the hospital stay. Studies reporting on specific removal times did not find differences in outcomes. No study addressed flexible removal time. Conclusions There is inconclusive evidence that earlier removal results in less UTIs, despite the incidence of UTIs increasing if the IDUC is removed ≥24 h. Immediate or after 1–2 day(s) removal does not lead to higher re‐catheterisation rates while immediate removal results in earlier ambulation and shorter length of hospital stay. Implications of key findings Nurses should focus on early IDUC removal while being aware of urinary retention.

ObjectivesTo explore the perceptions and experiences of patients who underwent transsphenoidal pituitary gland and (para)sellar tumour surgery regarding indwelling urinary catheters (IDUCs) and the postoperative fluid balance.DesignQualitative study using semistructured interviews based on the attitudes, social influence and self-efficacy model and expert knowledge.ParticipantsTwelve patients who underwent transsphenoidal pituitary gland tumour surgery and received an IDUC during or after surgery.SettingOne patient was interviewed in the endocrinology outpatient clinic and 11 patients were interviewed on the neurosurgery ward.ResultsFive major themes emerged: (1) conflicting information and preoperative expectations, (2) IDUCs perceived as patient-friendly during bedrest, particularly for women, (3) little room for patients’ opinions, (4) physical and emotional limitations and (5) fluid balance causes confusion. Information regarding IDUC placement and fluid balance given to patients both preoperatively and postoperatively did not meet their expectations, which led to confusion and uncertainty. The IDUC was perceived as preferable if bedrest was mandatory, preferred particularly by women. Patient could not mobilise freely due to the IDUC and felt ashamed, judged by others and dependent on nurses.ConclusionsThis study provides insight into the challenges patients experience in relation to the IDUC and fluid balance. Perceptions on the necessity of an IDUC varied among patients and were influenced by both physical and emotional impediments. A clear, frequent and daily communication between healthcare professionals and patients to evaluate IDUC and fluid balance use is necessary to increase patient satisfaction.

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BackgroundIndwelling urinary catheters (IDUCS) are frequently routinely inserted during transsphenoidal pituitary gland tumour surgery or spinal fusion surgery despite literature stating that there are no indications for using IDUCS during or after these surgeries. The aim of the study is to reduce the number of inappropriately inserted IDUCs in during or after transsphenoidal pituitary gland tumour surgery and spinal fusion surgery with an operation time of <4 hours. Methods A pragmatic, before-and-after mixed-methods observational study including medical chart analysis, satisfaction surveys with patients and healthcare professionals and multidisciplinary group interviews to assess the effectiveness of and experiences with various non-invasive de-implementation strategies aimed to decrease the number of inappropriate IDUCS inserted during and after transsphenoidal pituitary gland tumour surgery and spinal fusion surgery in a multicentre context. Discussion This paper presents the study protocol of a multi-centred before and after trial that aims to reduce inappropriate IDUC use after transsphenoidal pituitary gland tumour surgery and spinal fusion surgery, and thereby reducing UTIs, shortening hospital stay and increasing patient comfort. The results can be used to de-implement IDUCs after a broad range of surgeries on several wards.Trial registration The study has been submitted to the Dutch Trial Register (NTR).