Are Foley catheters needed after minimally invasive repair of pectus excavatum?

Area of Science:

• Pediatric Surgery
• Urology
• Anesthesiology

Background:

• Minimally invasive repair of pectus excavatum (MIRPE) can lead to high narcotic requirements, increasing urinary retention risk.
• The use of intraoperative Foley catheters to mitigate this risk varies.
• This study investigates the incidence of urinary retention following MIRPE.

Purpose of the Study:

• To determine the rate of urinary retention in patients undergoing MIRPE.
• To evaluate the efficacy of intraoperative Foley catheter placement in preventing urinary retention.
• To provide evidence-based guidance for clinical practice regarding Foley catheter use in MIRPE.

Main Methods:

• Retrospective review of 360 patients who underwent MIRPE between January 2012 and July 2016 at two academic children's hospitals.
• Data collection included patient demographics, BMI, pectus defect severity, pain management strategies, and incidence of urinary retention and urinary tract infection (UTI).
• Comparison of urinary retention rates between patients with and without intraoperative Foley catheters, and analysis of risk factors including pain management.

Main Results:

• Of 360 patients, 218 received an intraoperative Foley catheter, often associated with epidural pain control.
• The urinary retention rate was 34% in patients without a Foley catheter versus 1% in those with an intraoperatively placed Foley.
• Epidural pain control was identified as a significant risk factor for urinary retention in the absence of a Foley catheter (55% vs. 26% with patient-controlled anesthesia). No UTIs were reported.

Conclusions:

• Intraoperative Foley catheter placement effectively prevents urinary retention after MIRPE.
• This intervention does not increase the risk of urinary tract infections.
• Findings support routine use of intraoperative Foley catheters to improve patient outcomes and inform surgical counseling.