Impact of enhanced recovery after cesarean protocol on postoperative urinary retention

Q: How did the ERAC protocol affect time to Foley catheter removal?

Time to Foley removal after cesarean delivery decreased significantly in the post-ERAC cohort.

Q: Did implementing the ERAC protocol significantly change the incidence of POUR?

No statistically significant difference in POUR incidence was found between pre-ERAC and post-ERAC groups, though a trend toward increased incidence was noted.

Sep 30, 2026

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Objective Postoperative urinary retention (POUR) remains a frequent concern after cesarean delivery, prompting Enhanced Recovery After Cesarean (ERAC) pathways intended to speed recovery. This study assessed whether implementing an ERAC protocol changes POUR incidence following cesarean delivery. Methods A secondary analysis compared patients before versus after ERAC implementation in a prospective longitudinal quality improvement cohort, excluding general anesthesia, significantly complicated cesareans, and chronic pain disorders. POUR was defined as failure to void spontaneously 6 hours after Foley removal; catheter duration and replacement were secondary outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

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Abstract

Objective

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Methods

International Urology and Nephrology (2026) 58:61–66 [https://doi.org/10.1007/s1](https://doi.org/10.1007/s1) 1255-025-04610-2 Impact of enhanced recovery after cesarean protocol on postoperative urinary retention M. Kaitlyn Coghlan1 · Liviu Cojocaru2 · Suzanne Alton1 · Autusa Pahlavan1 · Ariel Trilling1 · Hyunuk Seung1 · Bhavani Kodali1 · Sarah Crimmins3 · Katherine Goetzinger1 Received: 13 February 2025 / Accepted: 4 June 2025 / Published online: 26 June 2025 © The Author(s) 2025 Abstract Objective Postoperative urinary retention (POUR) remains a common concern associated with cesarean delivery (CD) . Recently, efforts have been made to expedite recovery after CD through Enhanced Recovery After Cesarean (ERAC) pathways. We aimed to evaluate whether the implementation of an ERAC protocol impacts the incidence of POUR after CD. Methods This is a secondary analysis of a prospective, longitudinal, quality improvement (QI) study of patients undergoing CD before and after implementation of an ERAC protocol. CD patients requiring general anesthesia, significantly complicated CD, and patients with chronic pain disorders were excluded. The primary outcome was POUR, defined as failure of spontaneous voiding 6 hours (h) after Foley catheter removal. Secondary outcomes were the duration of Foley catheter placement and replacement of Foley catheter. Results Three hundred-eight patients were included. The incidence of POUR was similar between groups pre-ERAC (44, 22.6%) vs post-ERAC (36, 31.8%), p = 0.08. Time to Foley removal following CD was significantly decreased in the postERAC cohort [10.1 h (7.2, 13.7) vs. 12.5 h (10.9, 17.8)](p < 0.001) . Need for Foley catheter replacement occurred at a similar rate (pre-ERAC: 1.0%; post-ERAC: 0.9%, p = 0.7) . Conclusions There was no significant difference in POUR after implementing an ERAC protocol, although a trend toward increased incidence was noted. Post-ERAC implementation resulted in a significant decrease in the duration of Foley catheter placement. Keywords Postoperative urinary retention · Postoperative complications · Cesarean delivery · Enhanced recovery · Recovery protocols · ERAS * M. Kaitlyn Coghlan [mkcoghlan@uabmc.edu](mkcoghlan@uabmc.edu) Katherine Goetzinger [kgoetzinger@som.umaryland.edu](kgoetzinger@som.umaryland.edu) 1 Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA 2 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA 3 Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA Introduction Level I evidence supports enhanced recovery after surgery protocols being associated with improved perioperative outcomes and should be considered standard of care atthe time of gynecologic surgery [1–3] . Similarly, cesarean delivery (CD), one of the most common surgical procedures performed in the United States [4], has seen the development of enhanced recovery after cesarean delivery (ERAC) . These multidisciplinary, standardized care approaches aim to improve outcomes surrounding CD [5] . Much of the focus of these pathways has been on decreasing inpatient and outpatient opioid use, as well as decreasing the length of inpatient stay (LOS), through the implementation of multimodal analgesia, improved patient education, and early ambulation [6–9] . While beneficial, the impact of measures taken to achieve these goals on other pelvic floor perioperative outcomes is not known. Postpartum urinary retention remains a common concern associated with childbirth. Postoperative urinary retention (POUR) following cesarean delivery is not well studied but may occur in up to 25% of patients [10]. The pathophysiology of urinary retention in the postpartum setting is likely multifactorial with physiologic, neurologic, and mechanical factors contributing. Ur

FAQs

What is postoperative urinary retention (POUR) in this study?

POUR was defined as failure to void spontaneously 6 hours after Foley catheter removal.

How did the ERAC protocol affect time to Foley catheter removal?

Time to Foley removal after cesarean delivery decreased significantly in the post-ERAC cohort.

Did implementing the ERAC protocol significantly change the incidence of POUR?

No statistically significant difference in POUR incidence was found between pre-ERAC and post-ERAC groups, though a trend toward increased incidence was noted.

Sep 30, 2026

Uploaded by Patrick