Same-day catheter-free discharge versus overnight observation after artificial urinary sphincter surgery: a systematic review and meta-analysis.

Introduction And Hypothesis: The aim of this study was to compare postoperative outcomes of same-day catheter-free discharge (SDS) and overnight observation (OBS) following artificial urinary sphincter (AUS) implantation.

Methods: A systematic literature search was performed in PubMed, Scopus, Cochrane Library, Google Scholar, and ClinicalTrials.gov up to April 2025. Studies comparing SDS and OBS in men undergoing AUS surgery were included. Main outcomes were postoperative urinary retention, emergency department (ED) visits within 90 days, and suprapubic catheter (SPC) placement. Risk ratios (RR) and 95% confidence intervals (CI) were pooled using a fixed-effects model. Risk of bias was assessed using the ROBINS-I tool.

Results: Six studies were included in the systematic review (n = 2424 patients), and four studies (n = 1085) were eligible for meta-analysis. There was no significant difference between SDS and OBS in urinary retention (RR = 1.44, 95% CI 0.81-2.56, p = 0.21) or ED visits within 90 days (RR = 0.91, 95% CI 0.59-1.42, p = 0.69). However, SDS was associated with a significantly reduced risk of SPC placement (RR = 0.28, 95% CI 0.09-0.81, p = 0.02). Risk of bias was moderate to serious in most included studies.

Conclusions: Same-day catheter-free discharge after AUS implantation demonstrated comparable short-term safety outcomes to overnight observation, with a reduced risk of suprapubic catheter placement. Further high-quality prospective studies are needed to validate these findings.