Immediate Catheter Removal Accelerates Recovery After Emergency Caesarean in Randomized Trial

Immediate removal of urinary catheters on the operating table following emergency caesarean section was associated with earlier ambulation, shorter hospital stays, and lower rates of asymptomatic bacteriuria compared with catheter removal at 24 hours postoperatively, according to a randomized controlled superiority trial conducted at a Nigerian tertiary hospital. Among 210 women randomly assigned in a 1:1 ratio between June 2021 and February 2022, immediate catheter removal led to a median time to ambulation of 10 hours compared with 28 hours in the 24-hour removal group (P < 0.001), while the median length of hospital stay was shortened from 3 days to 2 days (P < 0.001). Women in the immediate removal group also experienced significantly lower catheter-related discomfort, with mean scores of 0.34 ± 0.96 versus 4.14 ± 1.47 on a numerical rating scale (P < 0.001).

Significant bacteriuria, defined as at least 10⁵ colony-forming units per millilitre at 48 hours, occurred in 7.6% of women (8 of 105) in the immediate removal group compared to 18.1% (19 of 105) in the 24-hour removal group (relative risk 2.38, 95% CI 1.09 to 5.19; P = 0.023). This association persisted after adjusting for maternal age, parity, and gestational age (adjusted odds ratio 2.92, 95% CI 1.20 to 7.12; P = 0.018), with Escherichia coli identified as the predominant isolate in 66.7% of cases. However, no statistically significant differences were observed between groups in symptomatic urinary tract infection, fever, dysuria, urgency, or suprapubic pain, indicating that the identified bacteriuria was predominantly asymptomatic.

Acute urinary retention—the trial’s primary outcome, defined as the inability to void within 6 hours of catheter removal with a palpable bladder requiring recatheterization with drainage of at least 150 mL—occurred in 6.7% of women (7 of 105) in the immediate removal group versus 0% (0 of 105) in the 24-hour removal group (risk difference 6.7%, 95% CI 1.9% to 11.4%; Fisher’s exact P = 0.014). All seven women responded promptly to brief recatheterization and voided normally thereafter. Baseline characteristics were comparable between groups, and secondary outcomes monitored additional recovery indices, including time to first void and time to bowel sounds, analyzed by intention to treat.

The study notes that while Enhanced Recovery After Surgery (ERAS) protocols advocate early urinary catheter removal following caesarean delivery, previous supporting evidence was drawn predominantly from elective procedures rather than emergency surgeries, which carry distinct risks of bladder dysfunction, infection, and delayed recovery. The authors concluded that immediate catheter removal is a viable management option within ERAS pathways for appropriately selected women undergoing emergency caesarean section, providing enhanced comfort and faster recovery at the expense of a modest increase in transient, clinically detected urinary retention that resolved promptly with recatheterization. The trial was single-centre and retrospectively registered with the Pan African Clinical Trials Registry under trial identifier PACTR202607883695641, with findings pending confirmation in multicentre trials.

Subject of Research: Postoperative urinary catheter removal timing in emergency caesarean section

Article Title: Immediate versus 24-hour removal of urinary catheter after emergency caesarean section: a randomized controlled trial

Article References: Oluwole, T. E., Coker, O. S., Hilary, E., Israel, W., Abu, P., Tyo, T., Azuka, U., Gideon, Y. T., Ezekiel, O., & Jonah, U. (2026). Immediate versus 24-hour removal of urinary catheter after emergency caesarean section: a randomized controlled trial. BMC Pregnancy and Childbirth. https://doi.org/10.1186/s12884-026-10198-x

Image Credits: AI Generated

DOI: 10.1186/s12884-026-10198-x

Keywords: emergency caesarean section, urinary catheter removal, randomized controlled trial, acute urinary retention, asymptomatic bacteriuria, enhanced recovery after surgery, maternal health, postoperative recovery, Immediate, versus, hour, removal