Same day urinary catheter removal after pelvic organ prolapse surgery: a randomized controlled trial

For many women, the natural aging process or the physical demands of childbirth can cause the pelvic organs—the bladder, uterus, and rectum—to shift downward, pressing against the vaginal walls. This condition, known as pelvic organ prolapse, can be uncomfortable and disruptive, often requiring surgical repair to restore the organs to their proper position. While the surgery itself is a well-established solution, the recovery process presents its own set of challenges. A significant part of the post-operative routine involves a urinary catheter, a thin tube inserted to drain the bladder while the body heals from the trauma of the operation. Traditionally, doctors leave this tube in place for a full day after surgery, removing it only when the patient is ready to try urinating on their own the following morning. This waiting period, however, keeps patients tethered to a bed or chair, delays their ability to walk freely, and extends the time they must spend in the hospital.

Researchers have long wondered if this waiting period is truly necessary. Could removing the catheter sooner, perhaps on the very same day the surgery is performed, help patients recover faster without causing harm? The concern is that removing the tube too early might lead to urinary retention, where the bladder cannot empty properly, or increase the risk of infection. To answer this question, a team of surgeons and researchers at a major women's and children's hospital in Singapore set out to test two different approaches. They wanted to see if taking the catheter out six hours after surgery was just as safe as waiting until the next day, and whether the sooner removal offered any real benefits for the patient's journey back to health.

The study involved ninety-seven women who were undergoing major surgery to repair pelvic organ prolapse. The researchers divided these women into two groups using a random selection process, ensuring that the two groups were as similar as possible at the start. One group followed the standard practice: their catheters were removed the next morning, and they were asked to try urinating on their own at that time. The other group, the experimental group, had their catheters removed just six hours after their surgery was finished. These women were then asked to try to urinate within six hours of the tube coming out. The team carefully tracked how many women in each group could empty their bladders successfully, how long it took them to do so, and whether they experienced any complications like infections or the need for the tube to be put back in. They also measured how quickly the women could get out of bed and walk around, and how long they stayed in the hospital.

The results showed that removing the catheter on the same day did not cause more problems than waiting until the next day. In fact, the ability to urinate successfully was nearly identical in both groups. About forty-six percent of the women in the same-day removal group managed to empty their bladders on the first try, a rate that was statistically the same as the group that waited until the next day. The time it took for the women to urinate on their own was also very similar, with no significant difference between the two approaches. This suggests that the body's ability to regain bladder control is not necessarily accelerated by taking the tube out earlier, but it is certainly not harmed by it either.

While the bladder function outcomes were similar, the benefits of the earlier removal were clear in other areas. Women who had their catheters removed on the same day were able to get out of bed and walk around much sooner. More than half of the women in the early removal group were walking on the day of their surgery, compared to only two percent of the women who waited until the next day. This early movement translated directly into a shorter hospital stay. A significantly larger portion of the women in the same-day group were able to go home within one to one and a half days after their surgery, whereas fewer women in the standard group achieved this quick discharge. The rates of urinary tract infections and other complications remained low and were the same for both groups, confirming that the faster approach was safe.

The study did uncover a small nuance in how success was measured. When doctors looked at the patients and made a judgment call on whether the catheter removal was a success, they were less likely to say "yes" for the women who had the tube removed early. However, when looking at the hard numbers of how much urine was left in the bladder, the success rates were the same. This suggests that doctors might be more cautious or skeptical when a patient tries to go without a tube so soon, even if the physical evidence shows the bladder is working fine. The researchers also noted that the timing of the surgery itself seemed to matter. Women whose surgeries finished later in the afternoon appeared to have a harder time passing the test of urinating on their own, regardless of which group they were in. This hints that the time of day a surgery ends might influence how well a patient recovers bladder function, possibly because it disrupts the body's natural rhythms or leaves less time for the patient to try before going to sleep.

Ultimately, this research provides strong evidence that removing a urinary catheter on the same day as pelvic organ prolapse surgery is a safe and effective strategy. It allows women to get out of bed sooner, spend less time in the hospital, and avoid the discomfort of a tube for an extra day, all without increasing the risk of infection or other complications. While the body's bladder function recovers at a similar pace regardless of when the tube comes out, the earlier removal clearly supports a faster and more comfortable recovery for the patient. The findings suggest that hospitals can confidently adopt this quicker approach for suitable patients, perhaps paying close attention to the time of day the surgery concludes to ensure the best possible outcome.