Do You Actually Need That Foley After URS?

There are things we do in urology because someone taught us to, and we never really questioned it. Putting a Foley in after URS and JJ stent insertion is one of those things. It feels sensible. It’s what the registrar before you did. Nobody’s going to challenge you for doing it.

But a 2025 EULIS-YAU collaborative RCT out of Turkey actually tested whether it matters. And the short answer is: not really.

The Study

Single-centre RCT, 112 patients randomised 1:1 to Foley versus no Foley after flexible URS with JJ stent insertion (4.8 Fr, 26 cm). All had kidney or proximal ureteric stones under 2 cm, negative pre-op cultures, and a ureteric access sheath was used throughout. Dusting technique. Clean cohort, clean design.

They measured IPSS, ureteric stent symptom questionnaire scores, inflammatory markers (WBC, CRP, PCT), creatinine, VAS pain at discharge, and 30-day complications.

What They Found

No significant difference in voiding function, inflammatory markers, or biochemistry between the two groups. Complications were 5.4% in the no-Foley group versus 8.9% in the Foley group, all Clavien-Dindo I/II. The Foley group actually trended slightly worse, though not significantly.

The one signal worth noting: total body pain on the USSQ was lower in the Foley group. The catheter may help with early bladder spasm and fullness-related discomfort. That’s a real clinical observation, even if it doesn’t justify routine use.

Why It Matters to Us

In a high-volume stone unit, routine Foley placement adds nursing workload, patient discomfort, an extra removal step, and arguably some CAUTI risk, all for no proven biochemical or functional benefit. For most straightforward URS cases, you can leave it out.

Some patients will still benefit. Pre-existing OAB, significant haematuria, or anyone you’re worried about retention overnight. That’s clinical judgement, not a blanket policy.

The EULIS-YAU provenance gives this more weight than a single-centre curiosity. And honestly, it’s the kind of paper to have in your back pocket when someone asks why you didn’t put one in.