Removal of Foley Catheters in Live Donor Kidney Transplant Recipients on Postoperative Day 1 Does Not Increase the Incidence of Urine Leaks

Abstract

Catheterization of the urinary bladder during kidney transplantation is essential. The optimal time to remove the Foley catheter postoperatively is not universally defined. It is our practice to remove the Foley catheter on postoperative day 1 in live donor kidney transplant recipients who meet our standardized protocol criteria. We believe that early removal of Foley catheters increases patient comfort and mobility, decreases the risk of catheter associated urinary tract infections, and allows for decreased hospital length of stay. The hypothetical risk of early removal of Foley catheters would be the increased risk of urine leak. We reviewed 120 consecutive live donor kidney transplant recipients and found that there was not an increased incidence of urine leaks in patients whose Foley catheters were removed on postoperative day 1.

Old habits die hard; does early urinary catheter removal affect kidney size, bacteriuria and UTI after renal transplantation?

“…The study by Dantas et al also demonstrated the duration of urinary bladder catheterization as main risk factor for UTIs in posttransplant patients ( 24 ). Siskind et al found that removal of Foley catheters in live donor renal transplant recipients on postoperative day 1 decreases the risk of catheter-associated UTIs and length of hospital stay ( 7 ). It also improves patient comfort, and promotes early postoperative ambulation ( 8 ).…”

“…All aspects of pre- and postoperative care of renal transplant recipients need to be evaluated to ensure optimal patient safety and clinical outcomes. Catheterization of the urinary bladder during renal transplantation is essential because postoperative urine output measurement with Foley catheterization is essential ( 7 ). Its benefits include preparation of the bladder for anastomosis and monitoring subsequent urinary output ( 8 ).…”

“…The optimal time to remove the catheter postoperatively is controversial. The trend in most institutions is to err on the side of leaving the catheter in for a longer period of time, to ensure consistent urine output ( 7 ). Some recommend catheter removal on postoperative day 5 ( 9 ).…”

“…It also decreases patient mobility which increases the risk of venous thromboembolism, pneumonia, and hospital length of stay. It is suggested to remove the catheter on postoperative day 1 in live donor renal transplant recipients to prevent its complications ( 7 ).…”

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“…Similarly, early catheter removal may also be beneficial to pancreas transplant recipients. They are routinely inserted in renal transplant to allow for close monitoring of urine production, but multiple studies have shown that patients can safely tolerate catheter removal within 48 h of surgery [ 212 , 213 , 214 , 215 ]. Meta-analyses within other surgical specialities have demonstrated decreased incidence of urinary tract infections and retention with early removal [ 216 , 217 ].…”