Table 3.

Summary of perioperative urinary catheter use recommendations*

A. Avoid placing indwelling urinary catheters for these routine procedures: these are procedures for which it is considered inappropriate to place a catheter for the procedure, as the catheter risk is considered to outweigh the benefits for the patient.†‡
General surgery Laparoscopic cholecystectomy Open appendectomy Laparoscopic appendectomy without suprapubic port Open reducible inguinal, femoral, umbilical or epigastric hernia repair Laparoscopic reducible inguinal or femoral hernia repair by TAPP if bladder emptied before surgery Laparoscopic reducible umbilical or epigastric hernia repair Laparoscopic adjustable gastric banding	Orthopaedic surgery Unilateral total knee arthroplasty Unilateral/bilateral unicompartmental knee arthroplasty Unilateral osteotomy for unicompartmental or non-inflammatory knee disease Revision knee arthroplasty, to last ≤2 hours Unilateral (not revision) total prosthetic hip replacement (total hip arthroplasty) Unilateral closed reduction percutaneous pinning for femoral neck fracture
B. Procedures to consider removing indwelling urinary catheter before leaving the OR
General surgery Laparoscopic reducible inguinal or femoral hernia by TEP approach Laparoscopic Roux-en-Y gastric bypass§ Laparoscopic sleeve gastrectomy§ Open or laparoscopic ileocecectomy, hemicolectomy (right, transverse or left) or sigmoidectomy§ Laparoscopic subtotal colectomy§	Orthopaedic surgery Bilateral total knee arthroplasty§ Revision knee arthroplasty, to last >2 hours§ Unilateral partial prosthetic hip replacement§ Unilateral open reduction and internal fixation for hip fracture§ Unilateral total prosthetic replacement for hip fracture§ Bilateral total hip replacement/arthroplasty§ Revision prosthetic hip replacement§
C. Procedures in which urinary catheter use in the OR and until at least postoperative day 1 is appropriate, with the timing for the first trial of void detailed below by procedure
General surgery Laparoscopic biliopancreatic diversion with duodenal switch (postoperative day 1)¶ Open subtotal colectomy (postoperative day 1) Open or laparoscopic rectal resection of the upper one-third of the rectum§ (postoperative day 1) Laparoscopic low anterior resection (postoperative day 1)** Open abdominal perineal resection (postoperative day 2)†† Open or laparoscopic total proctocolectomy‡‡	Orthopaedic surgery See section B for procedures§ in which removal on postoperative day 1 is also appropriate. It is inappropriate to wait until postoperative day 2 or later to remove catheters after routine hip or knee arthroplasty procedures, including hip fracture repair.

*These are recommendations for perioperative urinary catheter use for patients without another indication for urinary catheter use (eg, not needed to address a medical indication such as critical illness for which hourly urine output is being used to guide therapy such as vasopressors). For all procedures, using a postoperative protocol to monitor and address urinary retention symptoms is recommended; bladder scanners are increasingly common tools to verify retention in patients with symptoms to avoid unnecessary catheterisations.

†Routine urinary catheter use is not appropriate for these procedures when less than 2 hours of OR time and less than 2 L of intravenous fluids anticipated in the OR. Experts indicated that routine catheter use during the OR case could be appropriate for procedures >3 hours in duration or with >3 L of intraoperative fluids.

‡Patients are recommended to void before surgery. If concerned about postvoid residual, use of bladder scanner protocol with intermittent straight catheter as needed before surgery is an appropriate alternative to routine indwelling catheter use in patients with urinary retention.

§For these procedures, it was assessed also as clinically appropriate to remove catheter on postoperative day 1.

¶For this procedure, there was uncertainty about appropriateness of routinely removing on the same day of surgery; therefore, it could be clinically appropriate to remove earlier than postoperative day 1 by surgeon’s discretion.

**For open low anterior resection, removal before postoperative day 3 is appropriate, but there was uncertainty for whether removal was more appropriate on postoperative day 1 compared to postoperative day 2.

††For laparoscopic abdominal perineal resection, removal by postoperative day 4 is appropriate, but there was uncertainty for whether a particular day within the range of postoperative days 1–4 was more appropriate than others.

‡ ‡For open or laparoscopic total proctocolectomy with or without ileal pouch anal anastamosis, removal by postoperative day 4 is appropriate, but there was uncertainty for whether a particular day within the range of postoperative days 1-4 was more appropriate than others.

OR, operating room; TAPP, transabdominal preperitoneal; TEP, totally extraperitoneal.