Urinary catheters after surgery

This card explains urinary catheters, the thin tubes that drain urine from the bladder, with a focus on their use around surgery. It covers the main types, how long a catheter may stay in, basic care and the warning signs that sources list. It is general information for patients, families and students, and the surgical team's own instructions come first.

What it is

An NHS overview describes a catheter as a tube that drains the bladder, with the urine collected in a bag. The Centers for Disease Control and Prevention (CDC) lists four common kinds. An indwelling catheter is inserted through the urethra, left in place and connected to a closed collection system. An intermittent ("in and out") catheter is inserted briefly to drain the bladder and then removed. A suprapubic catheter is placed surgically through an incision in the lower abdomen. An external catheter, such as a soft sheath that fits over the penis, collects urine without entering the bladder.

The NHS adds that an indwelling catheter is held in place by an inflated balloon in the bladder, and that it is more convenient than intermittent catheters but more likely to cause infections. Unfamiliar terms are defined in the glossary.

Why it is done

The NHS lists several reasons for using a catheter: difficulty passing urine, such as from blockage by scarring or an enlarged prostate; nerve damage or bladder weakness; draining the bladder before, during or after some surgeries; delivering medicine directly into the bladder; and, as a last resort, for incontinence when other treatments have not worked.

The CDC guideline for preventing catheter-associated infections names perioperative use for selected procedures as an appropriate indication. Examples include urologic surgery or surgery on nearby structures, an expected long operation, and expected large-volume infusions or diuretics, or the need to monitor urine output, during surgery. The same guideline says the catheter should be removed as soon as possible after the operation, preferably within 24 hours, unless there are appropriate reasons for continued use. Plans differ by operation, for example after prostate resection, so the surgeon's own plan governs.

How it is done, in outline

The CDC guideline says catheters should be inserted only by properly trained people using aseptic (sterile) technique. It also stresses hand hygiene and a closed drainage system after insertion. A suprapubic catheter is placed through the abdomen instead of the urethra. For example, the British Association of Urological Surgeons leaflet on urethrotomy and urethral dilation says a temporary catheter may be needed for one to ten days afterward.

Recovery

Short-term catheters may stay in for minutes, hours or days, according to the NHS, whereas long-term catheters are typically indwelling and come with detailed care teaching before discharge. For long-term catheters the NHS says the catheter itself should be replaced at least every 3 months, and leg bags and valves changed every 7 days. The CDC guideline, by contrast, does not recommend changing catheters or bags at fixed intervals, and favors changing based on clinical need, so local policy matters.

Care basics are consistent across the sources. Wash hands before and after touching the catheter or bag. Clean the skin where the catheter enters the body each day with mild soap and water. Keep the bag below the level of the bladder, avoid kinks, and do not tug or pull on the tubing. Drink enough fluid to keep urine pale. The NHS says to empty the bag when it is about half to three-quarters full. MedlinePlus adds that physical activity should be avoided for a week or two after a catheter is placed. For wider recovery topics, see the recovery and rehabilitation hub and pelvic floor muscle training.

The NHS says to contact the community nurse right away for severe or ongoing bladder spasms, a blocked catheter or leaking around it, bloodstained urine or bright red blood, signs of urinary infection (lower abdominal pain, high temperature, feeling hot, cold or shivery), or an indwelling catheter that has fallen out when you do not know how to replace it. If the nurse cannot be reached, it advises calling 111. MedlinePlus lists further reasons to contact a provider, including pain in the sides or lower back, foul-smelling or cloudy urine, discharge around the insertion site, grit or stones in the urine, and a bag filling unusually quickly.

Risks

The NHS names urinary tract infections (UTIs), bladder spasms, leakage, blockages and damage to the urethra, and says infection risk rises the longer a catheter is used. The CDC calls prolonged use of a urinary catheter the most important risk factor for catheter-associated UTI (CAUTI), and states that about 75 percent of UTIs developed in hospitals are associated with a urinary catheter.

The CDC advises patients to understand why they need the catheter and to ask frequently whether it is still needed.

Questions to ask your clinician

• Why do I need a catheter after this operation, and what type will it be?
• How long is it expected to stay in, and who will remove it?
• Will I go home with it, and who will teach me to empty and change the bag?
• Which symptoms mean I should call the nurse, and what number should I use out of hours?
• What should I do if the catheter falls out or stops draining?