The optimal duration of catheterisation following transurethral resection of the prostate (TURP) remains a subject of debate. While prolonged catheterisation may reduce the risk of postoperative haemorrhage, it has been associated with higher rates of urinary tract infections (UTIs) and prolonged hospital stays. Conversely, early catheter removal may expedite recovery and reduce infection risk but could increase the likelihood of re-catheterisation. This systematic review and meta-analysis compare early (≤2 days) versus late (≥3 days) catheter removal following TURP to assess its impact on clinical outcomes and optimise post-operative recovery.

A systematic search of MEDLINE, Embase, and the Cochrane Library was conducted in February 2025. The Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool were used to assess study quality. Primary outcomes included the incidence of UTIs, postoperative haemorrhage, and re-catheterisation rates. Secondary outcomes included clot retention, and epididymitis. Effect sizes were calculated using pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). Publication bias was assessed using Egger’s test and trim-and-fill analysis.

A total of 13 studies, encompassing 1,249 participants, met the inclusion criteria. In general studies were of good quality with low statistical heterogeneity. Meta-analysis revealed no significant differences between early and late catheter removal groups in terms of re-catheterisation rates (RR= 0.86, 95% CI 0.58, 1.28 p = 0.36), postoperative haemorrhage (RR=0.86, 95% CI 0.52, 1.41 p = 0.55), or epididymitis (p = 0.22). However, early catheter removal was associated with significantly lower rates of UTIs (RR=0.43, 95% CI 0.27, 0.69 p < 0.001) and clot retention (RR=0.48, 95% CI 0.25, 0.91 p = 0.02).

The findings of this meta-analysis suggest that catheter removal at ≤2 days post-TURP reduces the incidence of UTIs and clot retention without increasing the risk of re-catheterisation or postoperative complications. Additionally, early catheter removal allows a shorter length of hospital stay, which has important implications for healthcare resource utilisation. These results indicate that routine catheterisation beyond 2 days post-operatively may not provide additional clinical benefits and should be reconsidered in favour of an individualised assessment based approach.