How Long Is a Transurethral Catheter Necessary in Patients Undergoing Thoracotomy and Receiving Thoracic Epidural Analgesia? Literature Review

DESPITE THE AGING POPULATION and new lung cancer cases being on the rise, clinicians are forced to be more efficient and more productive without additional resources. Fast-track pathways have been described showing outstanding results, such as a faster recovery process and shorter length of hospital stay, but mainly for abdominal and orthopedic surgeries. Although enhanced recovery paths might seem to be an excellent option to solve this problem, there is a scarcity of trials in thoracic surgery in general on this subject. Therefore, it is essential to implement recovery pathway programs for patients undergoing thoracic surgery. Thoracic epidural analgesia (TEA) is the gold standard to relieve pain after thoracotomy because of its association with severe pain. Thus, a crucial point to implement a fast-track pathway in thoracic surgery is to offer TEA. It reduces significantly the incidence of postoperative morbidity compared with other types of analgesia. In contrast, TEA encompasses important side effects. Postoperative urinary retention (POUR) is one of the most frequent, with an average incidence of 26%. To avoid this complication, it is a common practice to place a transurethral catheter, as long as the epidural is in situ and functioning well. Nevertheless, a urinary bladder catheter impedes early ambulation and can lead to urinary tract infection (UTI), which increases patients’ hospital length of stay and governmental costs. Recent studies have reported that transurethral catheters can be removed earlier safely in thoracic surgery patients. Hence, the goal of the present review was to determine when is the most appropriate timing to remove the bladder catheter in patients undergoing thoracic surgery receiving TEA. This paper reviews the literature to provide recommendations from experts’ opinions for both the appropriate removal period of the indwelling bladder catheter and the management of POUR for patients scheduled for thoracotomy receiving working TEA.