LAUSR

Background: British Association of Urological Surgeons (BAUS) published updated guidance on the Enhanced Recovery Programme (ERP) in December 2015 to include avoidance of routine catheterisation and drain insertion in minimally invasive nephrectomy. We changed our practice to ‘catheter-free’ nephrectomy and present a retrospective comparative study of the outcomes in support of this guideline. Aim: The aim of this article is to assess any difference in length of stay (LOS), complications and readmission rates between patients who had catheter-free nephrectomy compared to those who had a catheter inserted as routine peri-operatively. Method: Catheter-free nephrectomy was implemented in May 2014. A retrospective comparative case note review was performed for all eligible patients from January 2013 until May 2015. All partial and radical nephrectomies (laparoscopic or robotic) were included, regardless of pathology. Results: Ninety-two patients were included. Of these, 45 patients had a routine catheter inserted peri-operatively (17 partial, 8 simple, 20 radical), and 47 patients had a catheter-free nephrectomy (22 partial, 2 simple, 23 radical). Mean age difference between groups was non-significant (61.0 vs 60.3 years, p = 0.82). LOS was longer in the catheter group compared to catheter-free group (mean 3.85 vs 2.53 days, median 3 vs 2 days, respectively, p = 0.029). There were 13 complications in the catheter group, two of which were complicated urinary tract infections, causing one readmission. In the catheter-free group there were six postoperative complications and no readmissions; three patients went into acute urinary retention requiring either short-term intermittent self-catheterisation or ‘in/out’ catheterisation. None of these patients were discharged with a catheter. Conclusion: Nephrectomy without routine insertion of a catheter appears to be safe and was associated with a shorter hospital stay and no increase in complications, hence supporting the updated ERP guideline published by BAUS.