Comprehensive perioperative management: Prevention and treatment strategies for catheter-related bladder discomfort in urological surgery patients

Indwelling urinary catheterization, which is widely used in urological surgeries, predisposes patients to complications such as catheter-associated urinary tract infection, urethral trauma, and catheter-related bladder discomfort. Catheter-related bladder discomfort presents as suprapubic burning, dysuria, restlessness, or delirium; however it remains underrecognized in clinical practice, leading to suboptimal management during surgery. This narrative review summarizes the current evidence relating to the pathogenesis of catheter-related bladder discomfort, which is primarily associated with urothelial injury, muscarinic receptor-mediated detrusor overactivity, and neurogenic inflammation. In addition, the review identifies high-risk factors, including male sex, catheter diameter ≥18 Fr, and transurethral procedures. We highlight the need for uniform approaches to perioperative management, including preoperative pharmacoprophylaxis, intraoperative interventions, and postoperative therapies. Implementing these evidence-based approaches is essential to mitigate the incidence of catheter-related bladder discomfort and improve recovery and surgical outcomes in urological patients.