Factors associated with catheter-related bladder discomfort and its correlation with urinary catheter-related pain after minimally invasive urological surgery: a retrospective cohort study

Abstract

Background

Catheter-related bladder discomfort (CRBD) can significantly hinder patient recovery. Research on factors associated with CRBD following minimally invasive urological surgery under general anesthesia remains limited. Moreover, while urinary catheter-related pain (UCRP) has been recognized as a contributing factor to CRBD, the relationship between these two conditions remains poorly understood. Therefore, this study aimed to identify factors associated with CRBD and to investigate the correlation between UCRP and CRBD severity after minimally invasive urological surgery, with the goal of informing clinical prevention and management strategies.

Methods

A total of 150 patients who underwent minimally invasive urological surgery with indwelling urinary catheters under general anesthesia at the First Hospital of Jiaxing between October 2023 and August 2024 were included. Patient clinical data and information on the incidence and severity of CRBD were collected. Univariate and multivariate logistic regression analyses were performed to identify factors associated with CRBD; Spearman ‘s correlation analysis was used to examine the relationship between UCRP and CRBD severity.

Results

Among the 150 patients, 95 experienced CRBD and 55 did not, yielding an overall incidence of 63.33%. Multivariate logistic regression identified male sex (OR = 3.848, 95% CI: 1.553–9.535, P = 0.004), endoscopic surgery (OR = 2.205, 95% CI: 1.017–4.778, P = 0.045), absence of postoperative analgesia (OR = 2.763, 95% CI: 1.273–5.997, P = 0.010), and UCRP score > 3 (OR = 2.446, 95% CI: 1.096–5.459, P = 0.029) as factors independently associated with CRBD. Spearman ‘s correlation analysis revealed a significant positive correlation between UCRP and CRBD severity (r = 0.264, P = 0.001).

Conclusion

This observational study reveals a high incidence of CRBD after minimally invasive urological surgery. Factors independently associated with CRBD include male sex, endoscopic surgery, absence of postoperative analgesia, and UCRP score > 3. Furthermore, UCRP severity was positively correlated with the severity of CRBD.

Introduction

Catheter-related bladder discomfort (CRBD) ischaracterized by suprapubic discomfort and urinary urgency that typically emerge after general anesthesia, often manifesting as increased urinary frequency and urgency (Li et al. 2022; Mitobe et al. 2023; Shin and Doo 2019; Tang et al. 2025). As the use of indwelling urinary catheters has increased, the reported incidence of CRBD has ranged from 47 to 90% (Bai et al. 2015). CRBD is more prevalent among urological patients than in other surgical populations and can substantially compromise postoperative recovery (Kim and Kim 2020; Li et al. 2014). Previous studies have identified open abdominal surgery and a history of catheterization within the three months preceding surgery as factors associated with CRBD in urological patients (Kim and Kim 2020). However, the widespread adoption of minimally invasive techniques has led to a decline in open procedures, with laparoscopic and endoscopic approaches—including cystoscopy and ureteroscopy—now representing the standard of care in urology (Coptcoat 1992; Lombardo and Gundeti 2023; Niu et al. 2023; Watterson and Denstedt 2007). Despite this paradigm shift, research on the factors associated with CRBD specifically after minimally invasive urological surgery remains scarce.

Urinary catheter-related pain (UCRP) refers to pain arising from bladder or urethral spasms triggered by catheter placement. Although previous studies have examined CRBD and UCRP independently, and UCRP has been acknowledged as a contributing factor to CRBD (Lim and Yoon 2017), research examining the correlation between these two conditions remains limited. Therefore, this study aimed to integrate UCRP and CRBD assessments to identify factors associated with CRBD and to investigate the correlation between UCRP severity and CRBD severity in patients undergoing minimally invasive urological surgery. The findings are expected to inform the development of clinical strategies for the prevention and management of CRBD.

Materials and methods

Study population

This retrospective observational study included 150 patients who underwent minimally invasive urological surgery under general anesthesia at the First Hospital of Jiaxing between October 2023 and August 2024. The patient selection process is illustrated in Fig. 1. The study was approved by the Ethics Committee of the affiliated hospital of Jiaxing University (Approval number: 2024-KY-448). We confirm that our study complies with the Declaration of Helsinki. Given the retrospective design and the use of de-identified data from routine clinical care, the Ethics Committee granted a waiver of the requirement for prospective informed consent. However, all patients had provided general informed consent for the use of their clinical data for research purposes upon hospital admission as part of routine clinical care, in accordance with institutional policies.

Fig. 1.

Flow of patients through this retrospective study. Ultimately, 150 patients were enrolled who underwent minimally invasive urological surgery under general anesthesia

A total of 165 patients were initially screened. Of these, 15 were excluded: 1 refused participation, 6 had a history of urological injury, neurogenic bladder, urinary tract infections or overactive bladder, 5 had preoperative cognitive dysfunction, 3 received analgesics for intolerable pain before CRBD and UCRP assessment. Ultimately, 150 patients were enrolled.

Inclusion criteria: (1) age 18–80 years; (2) undergoing minimally invasive surgery with indwelling urinary catheter placement under general anesthesia; (3) provision of written informed consent; (4) no history of severe cardiopulmonary, hepatic, or renal dysfunction; and (5) American Society of Anesthesiologists (ASA) physical status I-III.

Exclusion criteria: (1) refusal to participate; (2) history of urological injury, neurogenic bladder, urinary tract infection, overactive bladder, or suprapubic discomfort; (3) preoperative cognitive dysfunction; (4) known allergy or adverse reaction to general anesthetics; (5) postoperative admission to the intensive care unit (ICU); (6) administration of analgesics for intolerable pain before CRBD and UCRP assessment; and (7) emergence agitation.

Anesthesia and surgical procedure

Thirty minutes before surgery, patients received standardized instruction on recognizing CRBD symptoms (such as suprapubic discomfort or burning sensation with urinary urgency) and distinguishing these from UCRP and incisional pain. Upon arrival in the operating room, intravenous access was established, and standard monitoring, including non-invasive blood pressure, electrocardiography (ECG), and pulse oximetry (SpO₂) was initiated. Invasive arterial blood pressure was monitored via radial or dorsalis pedis artery cannulation when clinically indicated. General anesthesia was induced with weight-based doses of sufentanil 0.3–0.5 µg/kg, rocuronium 0.6 mg/kg, and propofol 2 mg/kg. After loss of consciousness, an endotracheal tube or laryngeal mask airway was inserted, and mechanical ventilation was initiated with low tidal volume (6–8 mL/kg) and a respiratory rate of 12–14 breaths/min. Anesthesia was maintained with intravenous remifentanil 0.1–0.2 µg/kg/min and inhaled sevoflurane 2%.

Before surgical completion, experienced urologists inserted a double-lumen Foley catheter lubricated with liquid paraffin into the urethra. Once urine flow was observed, the catheter was advanced into the bladder, and 10 mL of sterile water was instilled into the balloon for fixation. The catheter was gently withdrawn until resistance was encountered, confirming placement at the bladder neck. The insertion depth was approximately 25 cm, and the catheter was secured to the pubic region with tape without tension.

At the end of the procedure, residual neuromuscular blockade was reversed with sugammadex sodium or a combination of atropine and neostigmine, at the anesthesiologist’ s discretion. Nalbuphine 0.2 mg/kg was administered intravenously at the time of surgical wound closure, approximately 15–20 min before extubation, for postoperative analgesia. When patients regained consciousness, demonstrated spontaneous breathing, and exhibited adequate muscle strength, the tracheal tube or laryngeal mask airway was removed.

Outcome measures

Demographic and clinical data included sex, age, body mass index (BMI), and history of catheterization. Intraoperative data recorded included surgical approach (endoscopic surgery vs. laparoscopic surgery), intraoperative duration, catheter type, postoperative analgesia, and muscle relaxation antagonist type (sugammadex sodium vs. atropine-neostigmine). Recovery data included CRBD severity and UCRP scores.

Catheter-Related Bladder Discomfort (CRBD) and Urinary Catheter-Related Pain (UCRP) assessments

Both CRBD and UCRP assessments were performed by trained post-anesthesia care unit (PACU) nurses who were blinded to clinical data, including surgical type and analgesic administration. All assessments were conducted at a standardized time point: 10 min after extubation, when patients were fully awake, oriented, and hemodynamically stable.

Preoperative patient education

Thirty minutes before surgery, all patients received standardized verbal and written instruction on recognizing and differentiating postoperative symptoms. Specifically, patients were educated that:

1. CRBD refers to a sensation of suprapubic discomfort, urinary urgency, or a burning sensation localized to the bladder region (lower abdomen, above the pubic bone), which is typically associated with catheter-induced bladder irritation.

2. UCRP refers to pain localized to the urethra (along the penile shaft in men or the vaginal area in women), often described as a burning, stinging, or sharp sensation during voiding or at rest, attributed to catheter-induced urethral mucosal irritation.

3. Incisional pain was distinguished as pain localized to the surgical wound site(s), typically exacerbated by movement or coughing.

4. General postoperative discomfort was defined as non-specific malaise, nausea, or diffuse pain not attributable to the catheter or surgical site.

Patients were instructed to report each symptom separately and were encouraged to ask questions to ensure understanding. This educational intervention was designed to minimize confusion between overlapping symptoms and to improve the accuracy of subsequent assessments.

CRBD assessment

Patients were categorized into CRBD and non-CRBD groups according to the presence or absence of CRBD. CRBD severity was assessed using a four-point scale (0–3):

0 (none): no urethral or bladder discomfort when queried;

1. (mild): mild urethral or suprapubic discomfort upon questioning, with no spontaneous complaints;

2. (moderate): self-reported catheter-related discomfort without behavioral responses (e.g., patient spontaneously reports discomfort but remains calm);

3. (severe): self-reported catheter-related discomfort with notable behavioral responses, such as verbal complaints, body movements, thrashing, or attempts to remove the catheter.

UCRP Assessment

UCRP was assessed using a Visual Analogue Scale (VAS), a 10-cm horizontal line anchored by "no discomfort" (0) at one end and "worst imaginable pain" (10) at the other. Patients were asked to mark the point on the line that best represented their urethral pain intensity. Patients with UCRP scores > 3 were categorized as having significant urethral pain for the purpose of regression analysis, based on the optimal cutoff identified by ROC analysis.

Sample size

Based on previously reported CRBD incidence rates ranging from 47 to 90% (Bai et al. 2015) and assuming an event rate of 70%, we estimated the required sample size. Ten parameters were proposed as potential associated factors. Applying the 10 events per variable (10-EVP) rule, a minimum of 143 patients was required. To account for a 15% attrition rate, we targeted enrollment of 165 patients.

Statistical analysis

Statistical analyses were performed using SPSS software (version 26.0; IBM Corp., Armonk, NY, USA). Normality of data distribution was assessed using the Shapiro–Wilk test and visual inspection of histograms. Normally distributed continuous variables are presented as mean ± standard deviation (SD), while non-normally distributed variables are expressed as medians and interquartile ranges (IQRs). Categorical data are presented as frequencies and percentages (%). Analysis of variance (ANOVA) was used for group comparisons, with post-hoc analysis performed using the least significant difference (LSD) t-test. Normally distributed continuous variables were compared using independent t-tests, whereas non-normally distributed variables were analyzed using the Mann–Whitney U test. Categorical variables were compared using the chi-squared test.

Data completeness was assessed for all variables. Complete data were available for all 150 patients for all analyzed variables, including demographic characteristics and outcome measures. No missing data were identified for any of the study variables, as the data were extracted from the institutional electronic medical records and PACU assessment forms, which are mandatory documentation in routine clinical care at our institution. Consequently, no imputation methods were required.

Univariate analysis encompassed demographic characteristics, intraoperative variables, and UCRP scores. Variables for the multivariable logistic regression model were selected based on both clinical plausibility and statistical significance. Clinically relevant variables including age, catheter size, history of catheterization, and operative duration were force-entered into the model regardless of their univariate P-values, based on previous literature and clinical reasoning. Additional variables with P < 0.1 in univariate analysis were considered for inclusion using a stepwise selection method. This approach was adopted to minimize the risk of omitting important confounders. Variables with P < 0.05 in the final multivariable model were considered to be independently associated with CRBD. The discriminative ability of UCRP for CRBD was evaluated using receiver operating characteristic (ROC) curve analysis, and the area under the curve (AUC) was calculated. Spearman ‘s rank correlation coefficient was used to examine the association between UCRP and CRBD severity. A two-sided P < 0.05 was considered statistically significant.

Results

Demographic and clinical characteristics of the study population

A total of 150 patients were included, of whom 95 developed CRBD and 55 did not, yielding an overall CRBD incidence of 63.33%. Among patients with CRBD, severity was classified as mild in 26.32%, moderate in 52.63%, and severe in 21.05%.

Significant differences were observed between the CRBD and non-CRBD groups with respect to sex, surgical approach, postoperative analgesia administration, and UCRP scores. No significant differences were found in age, BMI, history of prior catheterization, operative duration, catheter type, or reversal agent used. Detailed data are presented in Table 1.

Table 1.

Demographic data of CRBD and non-CRBD group

	CRBD(n = 95)	Non-CRBD(n = 55)	F/× 2/Z	P
Sex			10.203	0.001
Male	83(87.37%)	36(65.45%)
Female	12(12.63%)	19(34.55%)
Age	60.25 ± 13.74	61.75 ± 12.52	−1.882	0.065
BMI			0.537	0.464
< 24	61(64.21%)	32(58.18%)
≥ 24	34(35.79%)	23(41.82%)
History of catheterization			0.445	0.505
Yes	52(54.74%)	27(49.09%)
No	43(45.26%)	28(50.91%)
Surgical approach			4.852	0.028
Endoscopy	54(56.84%)	21(38.18%)
Laparoscopy	41(43.16%)	34(61.82%)
Intraoperative duration			0.259	0.611
≤ 30 min	29(30.53%)	19(34.55%)
> 30 min	66(69.47%)	36(65.45%)
Catheter type			0.249	0.617
≤ 16F	5(5.26%)	4(7.27%)
> 16F	90(94.74%)	51(92.73%)
Postoperative analgesia			8.413	0.004
Yes	46(48.42%)	40(72.73%)
No	49(51.58%)	15(27.27%)
Muscle relaxation antagonist type			0.008	0.927
Sugammadex sodium	56(58.95%)	32(58.18%)
Atropine-neostigmine	39(41.05%)	23(41.82%)
UCRP	5.00,2.00	4.00,4.00	−2.028	0.048

Results are expressed as mean ± SD, percentages, or as medians, IQR

CRBD catheter-related bladder discomfort, BMI body mass index, UCRP urinary catheter-related pain

Univariate and multivariate logistic regression analysis

The occurrence of CRBD (0 = non-CRBD, 1 = CRBD) was designated as the dependent variable. Independent variables included sex, age, BMI, history of catheterization, surgical approach (endoscopic vs. laparoscopic), intraoperative duration, catheter type, postoperative analgesia, muscle relaxation antagonist type, and UCRP score. The coding of variables for univariate and multivariate analyses is presented in Table 2.

Table 2.

Variable assignment for univariate and multivariate analyses

Variable	Assignment
Sex	Male = 0; Female = 1
Age	≤ 60 = 0; > 60 = 1
BMI	< 24 = 0; ≥ 24 = 1
History of catheterization	No = 0; Yes = 1
Surgical approach	Endoscopy = 0; Laparoscopy = 1
Intraoperative duration	≤ 30 min = 0; > 30 min = 1
Catheter type	≤ 16 = 0; > 16 = 1
Postoperative analgesia	No = 0; Yes = 1
Muscle relaxation antagonist type	Atropine-neostigmine = 0; Sugammadex sodium = 1
UCRP	≤ 3 = 0; > 3 = 1

BMI body mass index, UCRP urinary catheter-related pain

Univariate analysis revealed that sex, surgical approach, postoperative analgesia, and UCRP score were significantly associated with CRBD (P < 0.05). Conversely, age, BMI, history of prior catheterization, operative duration, catheter type, and reversal agent were not significantly associated with CRBD (P > 0.05). Details are provided in Table 3.

Table 3.

Univariate logistic regression analysis affecting CRBD

	Univariate logistic regression
	Odds ratio(95% CI)	P
Sex	4.069(1.551–10.675)	0.004
Age	1.488(0.675–3.280)	0.325
BMI	1.314(0.596–2.900)	0.499
History of catheterization	0.931(0.432–2.006)	0.855
Surgical approach	2.303(1.041–5.094)	0.039
Intraoperative duration	0.762(0.330–1.758)	0.524
Catheter type	0.927(0.189–4.555)	0.925
Postoperative analgesia	2.942(1.314–6.587)	0.009
Muscle relaxation antagonist type	0.767(0.349–1.684)	0.509
UCRP	0.389(0.169–0.897)	0.027

CRBD catheter-related bladder discomfort, BMI body mass index, UCRP urinary catheter-related pain

Multivariate logistic regression analysis was performed using a stepwise method, incorporating clinically relevant variables (age, catheter type, history of catheterization, and intraoperative duration) along with variables with P < 0.1 from the univariate analysis. The results indicated that male sex (OR = 3.848, 95% CI: 1.553–9.535, P = 0.004), endoscopic surgery (OR = 2.205, 95% CI: 1.017–4.778, P = 0.045), absence of postoperative analgesia (OR = 2.763, 95% CI: 1.273–5.997, P = 0.010), and UCRP score > 3 (OR = 2.446, 95% CI: 1.096–5.459, P = 0.029) were independently associated with CRBD. Further details are listed in Table 4.

Table 4.

Multivariate logistic regression analysis affecting CRBD

	Multivariable logistic regression
	Odds ratio(95% CI)	P
Sex	3.848(1.553–9.535)	0.004
Age	0.392(0.675–3.244)	0.328
History of catheterization	0.103(0.414–1.858)	0.731
Surgical approach	2.205(1.017–4.778)	0.045
Intraoperative duration	0.234(0.349–1.797)	0.576
Catheter type	0.227(0.776–0.797)	0.776
Postoperative analgesia	2.763(1.273–5.997)	0.010
UCRP	2.446(1.096–5.459)	0.029

CRBD catheter-related bladder discomfort, UCRP urinary catheter-related pain

ROC curve analysis

An ROC curve for UCRP was constructed with CRBD occurrence as the state variable. The analysis demonstrated that UCRP had moderate discriminative ability for identifying patients with CRBD, with an AUC of 0.618 (95% CI: 0.522–0.714, P = 0.016). At a UCRP cutoff of > 3, the sensitivity was 80% and specificity was 43.6%. Table 5 and Fig. 2 provide further details.

Table 5.

ROC curve distribution of the UCRP for CRBD

	AUC	Sensitivity	Specificity	95%CI	P
UCRP	0.618	0.800	0.436	0.522–0.714	0.016

ROC receiver operating characteristic, AUC area under curve, CRBD catheter-related bladder discomfort, UCRP urinary catheter-related pain

Fig. 2.

ROC curve distribution of UCRP for CRBD in patients after minimally invasive urological surgery. ROC: receiver operating characteristic; AUC: area under curve; CRBD: catheter- related bladder discomfort; UCRP: urinary catheter-related pain

Spearman’s correlation analysis

UCRP was positively associated with the severity of CRBD (r = 0.264, P = 0.001). The results are shown in Table 6.

Table 6.

Correlation between UCRP and CRBD

	CRBD
	r	P
UCRP	0.264	0.001

CRBD catheter-related bladder discomfort, UCRP urinary catheter-related pain

Discussion

Indwelling catheters are essential and commonly used in surgical patients, significantly reducing the risk of bladder injury, facilitating fluid management, and preventing urinary retention (Dellimore et al. 2013; Feneley et al. 2015; Nollen et al. 2023). With advancements in patient comfort, surgeons increasingly opt to insert urinary catheters after general anesthesia. While this procedure can avoid discomfort during catheterization, most patients experience CRBD following general anesthesia, which manifests as suprapubic discomfort, increased urinary frequency, urgency, and, in some cases, involuntary leakage. Such discomfort can exacerbate postoperative pain and agitation, leading to complications such as surgical site dehiscence, bleeding, and even dislodgement of the catheter (Jang et al. 2020; Ren et al. 2023). Therefore, it is crucial to identify high-risk patients and implement targeted preventive measures to address the factors associated with CRBD, ultimately enhancing patient outcomes.

In our study, the incidence of CRBD after minimally invasive urological surgery was considerably high at 63.33%, with moderate and severe cases comprising 73.68% of the total. This elevated rate can be attributed to the complete loss of consciousness during anesthesia, which prevents the cerebral cortex from forming memories and adapting psychologically to the intubation process. Upon awakening, patients exhibit heightened sensitivity to foreign body sensations. Moreover, the relaxation of the urethral muscles during anesthesia results in a urethral caliber greater than in the awakened state. Consequently, when patients regain consciousness, the relatively large catheter can cause damage and edema to the urethral mucosa, thereby increasing the risk of CRBD (Shin et al. 2020; Veerman et al. 2022).

Our study involved 150 patients who underwent minimally invasive urological surgery with an indwelling urinary catheter during general anesthesia. Sex, surgical approach, postoperative analgesia administration, and UCRP were identified as factors independently associated with the development of CRBD in this patient population. The risk of developing CRBD in men was 3.848 times greater than in women, a finding that aligns with previous research (Binhas et al. 2011; Li et al. 2014). This increased risk is attributed to the male anatomy, which features an elongated urethra with two physiological curvatures and three regions of potential stenosis and enlargement (Galgano et al. 2021; Kim et al. 2007; Strasser et al. 1996). The fixed pubic bend complicates catheterization, making it easier to damage the urethral mucosa, thereby intensifying urethral irritation and discomfort (Koraitim 2008). Moreover, CRBD occurred more frequently following endoscopic surgery than laparoscopic procedures. This difference can be explained by the transurethral approach in endoscopic surgery, which frequently leads to bladder spasms and irritation in the suprapubic region and bladder triangle, increasing the risk of CRBD. Our study indicated a higher incidence of CRBD among patients who did not receive postoperative analgesia, corroborating findings by Li et al. The analgesic administered in this study, nalbuphine, is a novel opioid receptor partial agonist. It mitigates pain by activating kappa receptors in the spinal cord, suppressing the release of substance P, and reducing the transmission of pain signals to the central nervous system. Furthermore, activation of the kappa receptor downregulates the expression of pro-inflammatory cytokines and chemokines, offering an anti-inflammatory effect, decreasing pain sensitization, and contributing to adequate analgesia (Kubica-Cielińska and Zielińska 2015; Narver 2015). This finding aligns with our conclusion that UCRP > 3 was independently associated with CRBD.

While UCRP alone demonstrated moderate discriminative ability (AUC = 0.618), its clinical utility likely lies in being part of a multivariate risk stratification model. Future research should aim to integrate UCRP with other readily available factors, such as patient sex, age, catheter size, type of surgery, and perhaps preoperative anxiety scores, to develop a composite risk score or nomogram. Such a tool could more accurately identify high-risk patients who would benefit most from prophylactic interventions (e.g., pre-emptive anticholinergic medication), thereby moving toward personalized perioperative care.

Furthermore, a positive correlation was found between UCRP and CRBD severity, indicating that higher UCRP levels were associated with more severe CRBD. Because UCRP and CRBD were assessed at the same postoperative time point (10 min after extubation), UCRP should be interpreted as a concurrent correlate rather than a temporal predictor of CRBD. The positive correlation between UCRP and CRBD severity suggests that these two symptoms share overlapping pathophysiological mechanisms, likely related to catheter-induced urethral and bladder irritation. The urethra ‘s rich innervation, comprised of autonomic and sensory nerves, means that patients with an indwelling catheter may experience bladder spasms, leading to the stimulation of the suprapubic area and bladder triangle, which can cause urethral pain. Moreover, relaxation of the perineal muscles during anesthesia can facilitate deep catheter insertion, directly irritating the bladder triangle mucosa and aggravating postoperative urethral sensitivity, significantly increasing pain and the likelihood of CRBD. Therefore, implementing standardized perioperative pain management strategies can reduce the incidence of CRBD and enhance overall patient outcomes (Lin et al. 2024; Lu et al. 2022; Wang et al. 2022).

Given the retrospective nature of this study, the associations identified should be interpreted as correlational rather than causal. Although we refer to these variables as “independently associated factors,” this terminology reflects statistical adjustment for potential confounders in a multivariate model and does not imply true predictive or causal relationships. Prospective cohort studies are warranted to confirm our findings and to establish temporal relationships between these factors and CRBD.

This study has several limitations. First, there was a lack of continuous and dynamic assessments of UCRP and CRBD, and insufficient evaluations at multiple postoperative time points, making the correlation conclusions drawn after extubation less comprehensive. Second, as a retrospective study, it was limited by incomplete data collection, and potential factors influencing CRBD, such as smoking history, psychological anxiety, preoperative bladder volume, and preoperative pain treatments, were not included in the univariate and multivariate regression analyses. Third, the limited variability in catheter type as per surgical protocol precludes a full evaluation of its independent role. Future prospective studies designed to randomize or systematically control for catheter size are warranted to confirm our findings. Fourth, although our target sample size was 165 patients to account for 15% attrition, the final sample of 150 patients still exceeded the minimum requirement of 143 based on the 10-EVP rule; nevertheless, the smaller-than-targeted sample may limit the stability of the multivariable model. Moreover, the independent variables were not differentiated; for example, the use of postoperative analgesia was only referenced as nalbuphine, limiting the comprehensiveness of the conclusions. Finally, the evaluation of UCRP and CRBD relied on subjective scoring methods, which may have introduced subjective bias and reduced the objectivity of the findings.

CRBD is a clinical issue that warrants significant attention. In male patients undergoing minimally invasive urological procedures, especially those who undergo endoscopic surgery, do not receive postoperative analgesia, and present with a UCRP > 3, there is a heightened risk for CRBD. A positive correlation exists between UCRP and CRBD severity. For patients identified as high-risk due to these influencing factors, it is essential to enhance analgesic management to ensure standardized perioperative pain control and prevent adverse outcomes.

Conclusion

This observational study reveals a high incidence of CRBD after minimally invasive urological surgery. Factors independently associated with CRBD included male sex, endoscopic surgery, absence of postoperative analgesia, and UCRP score > 3. Moreover, UCRP was positively correlated with CRBD severity.

Authors’ contributions

JT contributed to the design and conceptualization of this study, wrote the majority of the paper and participated in data analysis. MY assisted in writing a small portion of the paper, analyzed and revised the data and polished the paper. HN was responsible for revising the initial draft of the paper, made the final decision regarding the publication version of the paper. And all authors read and approved the final manuscript.

Funding

The Scientific Research Fund of National Health Commission-Zhejiang Provincial Health Major Science and Technology Plan Project (WKJ-ZJ-2448), Zhejiang Clinovation Pride and Zhejiang TCM science and technology plan (2024ZL170). the National Clinical Key Specialty Construction Project-Oncology department (2023-GJZK-001), the Clinical Key Specialty of Zhejiang Province Anesthesiology (2023ZJZK001), the Zhejiang Provincial Traditional Chinese Medical Innovation Team of China under Grant No. (2022–19), Zhejiang Clinovation Pride-Herpes zoster neuralgia (CXTD202502014), the Key Supported Discipline of Jiaxing Medical Science—Anesthesiology (2023-ZC-001).

Data availability

The datasets generated and analyzed during the current study are not publicly available due to institutional privacy policies and the terms of the ethics committee approval, which restrict data sharing to protect patient confidentiality. However, de-identified data may be available from the corresponding author upon reasonable request and with the permission of the institutional ethics committee.

Declarations

Ethics approval and consent to participate

The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the Ethics Committee of the First Hospital of Jiaxing (Approval number: 2024-KY-448), which granted a waiver of prospective informed consent given the retrospective nature of the study and the use of de-identified clinical data. All patients had provided general informed consent for the use of their clinical data for research purposes upon hospital admission.

Consent for publication

All patients provided general informed consent for the use of their clinical data for research and publication purposes upon hospital admission, in accordance with institutional policies. No identifiable individual patient data are presented in this manuscript.

Competing interests

The authors declare no competing interests.