Our systematic review was performed according to PRISMA guidelines (5). For this study Institutional Review Board approval was not required. We included in our systematic review: original prospective or retrospective studies, randomized or non-randomized, published in peer reviewed journal, having at least an abstract, in English language, from inception until 2025 whereas we excluded, case reports and case series, comments as well as studies not reporting robotic cases.

A systematic search of available literature was conducted in August 2025, in PubMed, Web of Science, Cochrane library, Google scholar and Scopus databases. The research question structured according to PICO criteria, focused on men with localized prostate cancer (P), who underwent robotic radical prostatectomy (I), with comparison of different indwelling catheter removal times (C), to evaluate functional outcomes for patients (O).

A combination of related keywords waw used for the search: (Robotic prostatectomy) AND ((Catheter removal time) OR (indwelling catheter) OR (optimal catheter) OR (optimal catheter removal time)). Title screening was independently performed by two authors manually (NK & PM) and consensus among all the authors resolved any discrepancies. After duplicates were removed and non-English studies were excluded, relevant studies were assessed for eligibility, by being subjected to a full-text review, before being included in the systematic review.

Data extraction was performed using a standardized form shared by both reviewers. Baseline preoperative characteristics of the patients were recorded and also the relevant intra and post operative information were extracted. Complications were graded according to the Clavien-Dindo system (6). The quality of the non-randomized studies was assessed with the NewCastle-Ottawa Quality Assessment Tool(NOS) (7), with a total score 5 or less to be considered as low quality, a score of 6–7 intermediate and a score of 8 and above was considered as high quality. For randomized controlled trials we the Jadad Scale (8) was used.

It does not seem to be a consensus about the definition of early removal. There are studies that report removal of the catheter as early as post operative day (POD) 1 (9, 10), others POD 2 (11–14) and others on POD 3–4 (15–18). The list of the available studies is completed with few surgeons that point the early removal on POD 7 or later (19, 20). Most studies compare early vs. late removal, while some report outcomes of early removal without any direct comparison with group of late removal. Based on the published data, catheter removal on POD 3–4 appears to be the safest and most representative timing for early removal.

Across all studies, groups were matched for key preoperative factors that may influence the final outcomes (BMI, PSA, Gleason Score, stage, prostate volume) with no statistically significant differences (10, 14, 18). Most patients were relatively young (57–65 years old), had a BMI of 25–27 kg/m² and small to moderate prostate size (40–50 mL) (9–12, 14–20). The majority of included patients were operated for local or locally advanced cancer (T2 to T3a) with ISUP 1–3 and with no important lower urinary tract symptoms (IPSS 4–8) (11, 13–15).

The patients that were selected for inclusion in these studies represent the typical patient prostate cancer population that is commonly undergo robotic radical prostatectomy; therefore, and the reported outcomes are applicable to most urologic practices. We recommend that surgeons adopting early catheter removal begin with patients who have smaller prostate glands with low volume and organ confined disease. Baseline characteristics of patients are presented in Table 1.

Most studies did not emphasize perioperative outcomes focusing instead on complications and long-term outcomes after the early removal of catheter. Available data indicate no difference in estimated blood loss (EBL) (9, 11, 13, 15, 18) or operating time (12, 15, 17) between groups suggesting comparable surgical quality. However, the randomized control study (RCT) by Lista et al, reported a significantly shorter hospital stay for early removal (4 days vs. 6 days p < 0.001) (18). Importantly, the rate of anastomotic leakage (after catheter removal) was very low (0.9%–2%) (12, 14) and it does not seem to differ between early and standard of prolonged removal (9, 17, 18, 21). In our opinion this is one of the main outcomes (along with rates of continence, ureteral stricture or bladder neck contracture, retention and readmission) that can help to turn the tide towards early removal, and it seems to be in favor of early catheter removal. Despite the fact that the only data we have for readmission of patients comes from one study, the rate of readmission seems to be as low as 4.3% another factor that implies that early removal of the catheter is safe and efficient (12). The outcomes are shown in Table 2.

Key outcomes influenced by catheter removal timing include continence recovery, potency and of course the long-term ureteral stricture (or bladder neck contracture) formation. The data for continence are very revealing: continence recovery occurs sooner with early catheter removal, whereas prolonged catheterization may have a negative long-term impact (14, 20). Immediate continence rated after early removal seems to be as high as 86% and increases to 90% in 3rd postoperative month (9). These data are reinforced from the study of Hao et al, with a rate of 63% of immediate continence after POD 2 and only 46% for the standard POD 7 (19). Nevertheless these outcomes come with the cost of higher urinary retention rates which are reported at 11%–13% (12, 13) and with a clear disadvantage for the groups of early removal (1.5 vs. 9.5% p < 0.01) (17). In this point we must stress the fact that this complication does not have an impact on any long term outcomes, including urethral stricture or bladder neck contracture since all studies did not find any statistical significant difference between the analyzed patients (14, 16, 18, 20, 21).

Pain and discomfort from indewelling catheterization remain major postoperative complaints and are often cited as reasons for early removal. The main goal of a minimal invasive procedure is to decrease pain and discomfort of the patient and enable him to return to his everyday life more rapidly.

Although available data are limited, one study reported no statistical significant differences in pain scores (urethral, perineal and abdominal VAS scores) between POD 2 and POD 7 (13). A very interesting finding, however, comes from the study of Prasad et al. who compared patients with early catheter removal but with the presence of suprapubic catheter (SPT). Even though there were no important differences in pain and discomfort scales, when patients were asked about how bothersome is the (indwelling)) catheter, in POD 0 only 21% of the patients answered greatly (with 21% in the SPC group) whereas in POD7 the rate was 41% (vs. 25% in the SPC group). This directly implies that the discomfort is increasing according to the days of catheterization.