Early removal of urinary catheter leads to greater post-void residuals in patients with thoracic epidural.

Abstract

A recent study showed that the removal of a bladder catheter is safe in presence of thoracic epidural analgesia (TEA). However, the ability to void satisfactorily can be affected. The aim of this investigation is to determine whether patients with TEA are able to recover the micturition process. On the morning after the surgery patients were randomised into two groups: the early removal group (ERG) (n = 101), with the bladder catheter removed at the same time, and the standard group (SG) (n = 104), where the bladder catheter was kept as long as TEA was functioning (on average 3-5 days after surgery). Following the first micturition, patients underwent regular ultrasound scanning of the bladder until a post-void residual (PVR) less than 200 ml was reached. All of the patients in the ERG and in the SG started to void and recovered satisfactorily their ability to void, reaching a PVR < 200 ml without requiring a transurethral catheterisation. However, the length of time to reach a PVR < 200 ml in the ERG was significantly longer compared with the SG (345 min ± 169 vs. 207 min ± 122, P < 0.0001). In the presence of TEA, the removal of the bladder catheter on the morning after surgery leads to a transient impairment of the lower urinary tract function with no need for re-catheterisation.