traditionally , urinary catheter has been used in gynecological surgical practice to assess urinary output , to improve surgical exposure , reduce the possibility of injury to the urinary system and to prevent postoperative urinary retention . however , catheterization is mainly required to keep the bladder out of the operative site and later on until patient becomes ambulatory . shortest duration of the catheter is now a routine and unlike cesarean infection rate is much low even if kept for 24 - 48 h. although there seems to be no clinical uncertainty about the need for an empty bladder before and during surgery , controversy arises about the ideal time to remove the catheter postoperatively . few studies reported significantly less pain and urinary tract infection ( uti ) in after immediate removal , whereas others showed that early removal urinary catheter after uncomplicated hysterectomy seem to decrease first ambulation time and hospital stay without posing any threats . this prospective , randomized controlled trial was conducted in the department of obstetrics and gynecology of a tertiary care referral center from july 2008 to december 2009 . the aim of this study was to compare the outcomes of immediate removal of urinary catheter versus removal on the first day after abdominal hysterectomy for benign gynecological disease . informed consent was obtained from enrolled patients and protocol was approved by the institute 's ethical committee . seventy patients who underwent an uneventful abdominal hysterectomy with or without salpingoophrectomy were included in this study . patients with anticipated complicated surgical procedure requiring strict fluid replacement postoperatively , bladder suspension or colporraphy surgery , positive or unavailable preoperative urine culture report and co - morbid illness requiring strict intake output monitoring were excluded from the study . group i immediate removal of the catheter in the operating room.group ii catheter removal after 24 h. 
  group i immediate removal of the catheter in the operating room . group ii catheter removal after 24 h. randomization was performed by using a computer generated randomization table and allocation group was kept in sealed envelope . the operating surgeon was made aware of randomization and accordingly the patient was assigned to one of the two groups . in all cases , all patients received one dose of antibiotic prophylaxis at the time of surgery and continued postoperatively as per department protocol . a fresh catheter sample was taken for the urine microscopy and culture at the time of preoperative catheterization . later , on the basis of study assignment , catheter was removed either in the operating room immediately or 24 h postoperative . incidence of symptomatic utis , re - catheterization , subjective pain assessment and febrile morbidity was compared in both groups . pain was assessed with a pictorial questionnaire that assed the level of pain and location of pain , that is , bladder or urethra versus surgical site . febrile morbidity was defined as two consecutive oral temperatures of > 100.4f measured 6 h apart . need of recatheterization was assessed by an inability to pass urine at the end of 12 h , or failure to void after two attempts . the diagnosis of symptomatic uti was based on the presence of significant bacteriuria accompanied by at least one of the following symptoms : fever , dysuria , increased frequency of urination , urinary urgency , suprapubic pain , and burning micturition . a clear voided midstream urine specimen was obtained on . a second clean voided midstream urine sample for culture and sensitivity was obtained at 2 week postoperative visit . all the culture sensitivity reports were collected , recorded and patients with positive culture were treated according to the sensitivity . group i immediate removal of the catheter in the operating room.group ii catheter removal after 24 h. 
  group i immediate removal of the catheter in the operating room . group ii catheter removal after 24 h. randomization was performed by using a computer generated randomization table and allocation group was kept in sealed envelope . the operating surgeon was made aware of randomization and accordingly the patient was assigned to one of the two groups . in all cases , all patients received one dose of antibiotic prophylaxis at the time of surgery and continued postoperatively as per department protocol . a fresh catheter sample was taken for the urine microscopy and culture at the time of preoperative catheterization . later , on the basis of study assignment , catheter was removed either in the operating room immediately or 24 h postoperative . incidence of symptomatic utis , re - catheterization , subjective pain assessment and febrile morbidity was compared in both groups . pain was assessed with a pictorial questionnaire that assed the level of pain and location of pain , that is , bladder or urethra versus surgical site . febrile morbidity was defined as two consecutive oral temperatures of > 100.4f measured 6 h apart . need of recatheterization was assessed by an inability to pass urine at the end of 12 h , or failure to void after two attempts . the diagnosis of symptomatic uti was based on the presence of significant bacteriuria accompanied by at least one of the following symptoms : fever , dysuria , increased frequency of urination , urinary urgency , suprapubic pain , and burning micturition . a clear voided midstream urine specimen was obtained on . the second postoperative day for culture and sensitivity . a second clean voided midstream urine sample for culture and sensitivity was obtained at 2 week postoperative visit . all the culture sensitivity reports were collected , recorded and patients with positive culture were treated according to the sensitivity . groups were compared by the chi - square test . a p < 0.05 was considered to be statistically significant . a total of 70 women were enrolled in the study and equally assigned to two groups . all women had similar clinical characteristics , that is , age , indication for hysterectomy and duration of surgery [ table 1 ] . distribution according to clinical characteristics of 35 women only 3 ( 8.5% ) required recatheterization after immediate postoperative removal , while no one from late removal group needed to be recatheterized . twelve women had positive culture at day 2 postoperative out of which nine were from late removal group as compared to three patients of early removal group ( p = 0.222 ) . out of six culture positive cases at 2 weeks postoperative day , two women were from early removal group and four women from late removal group ( p = 0.532 ) . pain perception was also higher in late removal group ( 45.7% ) as compared to early group ( 40% ) . out of eight febrile patients on day 2 postoperative six patients were from group ii while the rest were from group i ( p = 0.133 ) and on day 3 postoperative day seven patient from late removal group were febrile when compared to three women of early removal group [ table 2 ] . three women out of nine culture positive cases in late removal group had symptoms of uti and fever . one women at 2 weeks who was positive for culture had a fever and other symptoms of uti . abdominal hysterectomy for dysfunctional uterine bleeding is now becoming rare as vaginal hysterectomy and total laparoscopic hysterectomy or laparoscopy - assisted vaginal hysterectomy has taken a lead role . utis comprise of all nosocomial infections and occur after urological instrumentation , usually urinary catheterization , in up to 75% of the patients . the potential squeal of urinary catheterization include gram negative bacteremia , antimicrobial toxicity , chronic bacteriuria and chronic renal disease .   with today 's heightened awareness of costs of medical care a nosocomial infection causing increased length of hospital stay would not only be a significantly morbid event , but also an economic consideration . hemantha senanayka from colombo showed that elective cesarean in 344 women without catheterization does not compromise the safety or ease of surgery . it reduces the risk of infection . a prospective randomized control trial conducted on 200 women by onile et al . showed that immediate removal of catheter after cesarean is associated with a lower rate of uti . various prospective trials have been conducted in other urogenital surgeries regarding early removal of the catheter . a prospective randomized study conducted on 90 women by sekhavat et al .   in anterior colporraphy showed that symptomatic uti was significantly lower in early catheter - removal group ; also patients in this group reported significantly less pain and voiding disturbances . this study demonstrated that the immediate removal of an in - dwelling catheter is safe and not associated with adverse effects . one interesting finding was that only three women in the early catheter - removal group required recatheterization after failing to void and none of these women had positive urine culture . we are aware that a possible criticism to our findings may lie in the fact that number of patients was limited . although our findings are strengthened by the fact the surgeon was made aware of the randomization only at the end of the operation , but , a limitation of our study may exist in the fact that the observer of outcome was not blinded to the randomization . however , it seems unlikely that the parameters evaluated in the study ( rate of recatheterization , symptomatic utis , fever ) were biased by the observer , considering that they were determined on the basis of standardized criteria . pain perception is a subjective measure , which could result in variations of perceived pain . early catheter removal after abdominal hysterectomy was associated with a lower incidence of positive urine culture . furthermore , there was no adverse outcome like significant rate of recatheterization and higher pain perception .