Annals of the Royal College of Surgeons of England · 2026
When is it best to remove a catheter: risk factors for catheter-related emergency room visits and failure of ex-catheterisation.
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Elsweefy M, Patel A, Sharma N, Bassett P, Batura D
Аннотация
OBJECTIVES: We aimed to evaluate the nature and timing of catheter-related complications, identify factors influencing trial without catheter (TWOC) outcomes and determine a preferred interval to TWOC.
METHODS: Data from 672 patients referred for TWOC over 16 months included patient demographics, indication for catheterisation, urological history, interval to TWOC and TWOC outcome. Complication-free survival was assessed using Kaplan-Meier methods, predictors of complications by Cox regression, and factors associated with TWOC outcome by univariable and multivariable logistic regression.
RESULTS: The indication for catheterisation significantly influenced complication risks; patients catheterised for urinary retention were most likely to present with complications (p=0.02). No association was observed between TWOC timing and attendance at Accident and Emergency. Descriptive analysis demonstrated a substantial increase in complications from 6.9% at 7 days to 57% at 28 days postcatheterisation. TWOC success was unaffected by timing. Independent predictors of TWOC failure included age, sex and indication for catheterisation. Each ten-year increase in age was associated with a 24% higher risk of failure. Women were more likely to fail TWOC than men, and failure rates were highest in patients catheterised for urinary retention. In contrast, younger patients catheterised for monitoring or following surgery demonstrated more favourable outcomes.
CONCLUSIONS: Catheter-related complications occur most frequently within four weeks, suggesting TWOC within this timeframe. Older age, female sex and urinary retention as the cause for catheterisation are associated with greater risks of failure. Catheterisation in these groups should therefore be reserved for strict indications. Younger and postoperative patients may undergo TWOC once clinically safe.
METHODS: Data from 672 patients referred for TWOC over 16 months included patient demographics, indication for catheterisation, urological history, interval to TWOC and TWOC outcome. Complication-free survival was assessed using Kaplan-Meier methods, predictors of complications by Cox regression, and factors associated with TWOC outcome by univariable and multivariable logistic regression.
RESULTS: The indication for catheterisation significantly influenced complication risks; patients catheterised for urinary retention were most likely to present with complications (p=0.02). No association was observed between TWOC timing and attendance at Accident and Emergency. Descriptive analysis demonstrated a substantial increase in complications from 6.9% at 7 days to 57% at 28 days postcatheterisation. TWOC success was unaffected by timing. Independent predictors of TWOC failure included age, sex and indication for catheterisation. Each ten-year increase in age was associated with a 24% higher risk of failure. Women were more likely to fail TWOC than men, and failure rates were highest in patients catheterised for urinary retention. In contrast, younger patients catheterised for monitoring or following surgery demonstrated more favourable outcomes.
CONCLUSIONS: Catheter-related complications occur most frequently within four weeks, suggesting TWOC within this timeframe. Older age, female sex and urinary retention as the cause for catheterisation are associated with greater risks of failure. Catheterisation in these groups should therefore be reserved for strict indications. Younger and postoperative patients may undergo TWOC once clinically safe.