Midnight removal of urinary catheters — Improved outcome after gynecological surgery

By convention, most indwelling urethral catheters are removed in the morning. The authors carried out a randomized prospective study of 101 patients with postoperative urethral catheters and compared midnight removal with the more usual practice of morning removal. Patients were randomized into two groups: group A (n=46) had their catheters removed at 6:00 am and group B (n=49) had their catheters removed at midnight. Six patients were excluded from the study (1 patient on distigmine and 5 with preexisting urinary tract infections). The groups were comparable in age, use of night sedation, operative procedures and incidence of postoperative urinary tract infections. Patients in group B passed urine a median of 1 hour 40 minutes earlier, with a median volume 175 ml greater than group A (P=0.012 and <0.001); 13 patients in group A subsequently required recatheterization for urinary retention, compared to only 6 patients in group B. Patients in group B were also discharged significantly earlier from hospital (median of 2 days earlier from removal of catheter) than those in group A (P=0.032). Midnight removal of indwelling catheters after gynecologic surgery significantly decreases hospitalization and improves bladder function in terms of time and volume of first void.