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Updated: Feb 8, 2026
An In Vitro Bladder Model of Catheter-Associated Urinary Tract Infection
Published on: June 24, 2025
Foley catheters are not routinely necessary in children treated with patient-controlled analgesia following
Yangyang R Yu1, Richard Sola2, Somala Mohammed3
1Baylor College of Medicine, Michael E. DeBakey Department of Surgery, One Baylor Plaza, Houston, TX 77030; Texas Children's Hospital, Division of Pediatric Surgery, 6701 Fannin Street, Houston, TX 77030.
Insights
Routine Foley catheter use in children with perforated appendicitis is unnecessary. The study found a low risk of urinary retention, even with patient-controlled analgesia (PCA), suggesting Foley catheters are not required to prevent this complication.
Area of Science:
- Pediatric Surgery
- Urology
- Anesthesiology
Background:
- Patient-controlled analgesia (PCA) is common for children with perforated appendicitis.
- Foley catheters are sometimes used to prevent urinary retention in these patients.
- The necessity of routine Foley catheterization requires investigation.
Purpose of the Study:
- To evaluate the necessity of routine Foley catheter placement in children with perforated appendicitis receiving PCA.
- To determine the incidence of urinary retention in this patient population.
Main Methods:
- Retrospective review of children (≤18 years) with perforated appendicitis and postoperative PCA.
- Data collected from two academic children's hospitals between July 2015 and June 2016.
- Urinary retention defined as inability to void spontaneously, requiring catheterization.
Main Results:
- Of 313 patients, 129 received an intraoperative Foley catheter (varying by hospital).
- No significant difference in urinary retention rates between patients with (2%) and without (5%) an intraoperative Foley.
- Urinary tract infections were absent in both groups.
Conclusions:
- The risk of urinary retention in children with perforated appendicitis receiving PCA is low.
- Routine Foley catheter placement is not required to prevent urinary retention in this cohort.
Background:
Patient-controlled analgesia (PCA) is often used in children with perforated appendicitis. To prevent urinary retention, some providers also routinely place Foley catheters. This study examines the necessity of this practice.
Methods:
We retrospectively reviewed all children (≤18 years old) with perforated appendicitis and postoperative PCA from 7/2015 to 6/2016 at two academic children's hospitals. Urinary retention was defined as the inability to spontaneously void requiring straight catheterization or placement of a Foley catheter.
Results:
Of 313 patients who underwent appendectomy for perforated appendicitis (Hospital 1: 175, Hospital 2: 138), 129 patients received an intraoperative Foley (Hospital 1: 22 [13%], Hospital 2: 107 [78%], p < 0.001). Age, gender, and BMI were similar between those with an intraoperative Foley and those without. There were no urinary tract infections in either group. Urinary retention rate in patients with an intraoperative Foley following removal on the inpatient unit (n = 3, 2%) and patients without an intraoperative Foley (n = 10, 5%) did not reach significance (p = 0.25). On univariate analysis, demographics, intraoperative findings, PCA specifics, postoperative abscess formation, and postoperative length of stay, were not significant risk factors for urinary retention.
Conclusions:
The risk of urinary retention in this population is low despite the use of PCA. Children with perforated appendicitis do not require routine Foley catheter placement to prevent urinary retention.
Level Of Evidence:
II.
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