Early Catheter Removal Improves Recovery After Total Abdominal Hysterectomy: A Randomized Trial

To evaluate whether early removal of the urinary indwelling catheter enhances postoperative recovery in women undergoing uncomplicated total abdominal hysterectomy (TAH).

This open-label randomized controlled trial was conducted at a university hospital in Thailand between August 2023 and July 2024. Women aged 18-65 years scheduled for TAH for benign gynecologic conditions were randomized to early catheter removal (12-16 hours postoperatively) or standard removal (20-24 hours). Primary outcomes were time to first ambulation and six-minute walk test (6MWT) distance on postoperative days (POD) 1 and 2. Secondary outcomes included time to first voiding, urinary retention, urinary tract infection (UTI), catheter-related discomfort, hospital stay, costs, and patient satisfaction.

Of 105 patients screened, 100 were randomized; 93 completed the study (46 early removal, 47 standard removal). Baseline characteristics were comparable. Early catheter removal significantly reduced time to ambulation (18.69 ± 4.11 vs 21.41 ± 3.02 hours, p < 0.001) and time to first voiding (19.02 ± 3.72 vs 21.99 ± 3.46 hours, p < 0.001). 6MWT distances on POD1 and POD2 were slightly higher in the early group but not statistically different. Rates of urinary retention, symptomatic UTI, catheter-related discomfort, hospital stay, hospitalization costs, and patient satisfaction were similar across groups.

Early urinary catheter removal within 12-16 hours after uncomplicated TAH accelerates postoperative recovery, particularly ambulation and voiding, without increasing urinary complications, supporting its integration into ERAS protocols.