Catheter body-surface fixation after transurethral prostate resection: A low-value nursing practice as evidenced in a randomized controlled trial
RESEARCH ARTICLE
Catheter body-surface fixation after transurethral
prostate resection: A low-value nursing practice
as evidenced in a randomized controlled trial
Yanan Zhu 1, Qian Wang2, Huiying Jia3, Gaiyun Zhao4, Yunpeng Lü2, Xinhong Zhang2*,
Haijing Dong 5*
1 Emergency Department, Qingdao Municipal Hospital, Qingdao, Shan Dong, China, 2 Department of
Urology, Qingdao Municipal Hospital, Qingdao, Shan Dong, China, 3 Department of Cardiology, Qingdao
Municipal Hospital, Qingdao, Shan Dong, China, 4 Department of Operating Rooms, Qingdao Municipal
Hospital, Qingdao, Shan Dong, China, 5 Department of Nursing, Qingdao Municipal Hospital, Qingdao,
Shan Dong, China
* (DHJ); (ZXH)
Abstract
OPEN ACCESS
Citation: Zhu Y, Wang Q, Jia H, Zhao G, Lü Y,
Zhang X, et al. (2026) Catheter body-surface
fixation after transurethral prostate resection:
A low-value nursing practice as evidenced in a
randomized controlled trial. PLoS One 21(6):
e0350800. https://doi.org/10.1371/journal.
pone.0350800
Editor: Yashwanth Nanda Kumar, University of
Washington, UNITED STATES OF AMERICA
Received: February 11, 2026
Accepted: May 18, 2026
Published: June 4, 2026
Copyright: © 2026 Zhu et al. This is an open
access article distributed under the terms of
the Creative Commons Attribution License,
which permits unrestricted use, distribution,
and reproduction in any medium, provided the
original author and source are credited.
Data availability statement: The standardized
full data citation and permanent DOI are provided below:Dataset DOI: https://doi.org/10.6084/
m9.figshare.32197224. Readers and researchers can access the underlying data permanently
via the above link. We have supplemented and
This randomized controlled trial is aimed at evaluating whether external fixation of
the urinary catheter to the body surface represents a low-value nursing intervention
for patients undergoing transurethral resection of the prostate (TURP). A total of 208
patients who received indwelling urinary catheters after TURP in a tertiary hospital in
Qingdao, China between June 2024 and May 2025 were randomly assigned to one
of two groups: a nonexternal fixation group (n = 103) and an external body surface
fixation group (n = 105). A between-group comparison of outcomes included postoperative hematuria, incidence of catheter-associated urinary tract infection (CAUTI),
unplanned catheter removal, occurrence of urinary catheter-related meatal pressure
injury (UCR-MPI), and associated economic costs. No significant differences were
observed between the two groups in terms of postoperative hematuria or CAUTI
incidence (P > 0.05). Unplanned catheter removal did not occur in either group. However, UCR-MPI occurred significantly more frequently in the external fixation group (9
patients) than it did in the nonexternal fixation group (1 patient) (P < 0.05). Additionally, the external fixation group incurred higher costs for personnel and consumables.
External fixation of the urinary catheter to the body surface after TURP is associated
with increased economic costs, reduced patient comfort, and a higher incidence of
UCR-MPI, which indicates that it constitutes a low-value nursing practice. Nonexternal fixation appears to be a safe and effective alternative for post-TURP patients
undergoing early mobilization.
Introduction
Given the global backdrop of efforts by healthcare systems to enhance care value
and efficiency, the identification and reduction of “low-value care” has become a
PLOS One | https://doi.org/10.1371/journal.pone.0350800 June 4, 2026
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standardized all relevant data citations in the
revised manuscript accordingly.
Funding: This study was supported by the
Qingdao Municipal Health Commission (Grant
No. 2024-WJKY014). The funder played no
role in the study design, data collection, data
analysis, data interpretation, or writing of the
manuscript.
Competing interests: The authors declare no
competing interests.
critical imperative. Low-value care is typically defined as clinical practices that offer
minimal benefit to patients, of which the potential risks or costs may outweigh the
gains [1]. It is estimated that approximately 30% of healthcare services may be
categorized as wasteful or of low value [2,3], consuming finite medical resources and
potentially imposing unnecessary burdens on patients’ physical and psychological
well-being [2–5]. Therefore, the prudent evaluation and optimization of routine practices within nursing are essential for advancing evidence-based practice and achieving optimal resource allocation.
Transurethral resection of the prostate (TURP) is the standard surgical procedure for treating benign prostatic hyperplasia [6,7]. Postoperative indwelling urinary catheterization is typically needed. However, urinary catheter-related meatal
pressure injury (UCR-MPI) is a recognized complication, in which male patients are
at increased risk because of their anatomical characteristics [8,9]. With the widespread adoption of enhanced recovery after surgery (ERAS), early postoperative
ambulation for TURP patients has become an aspect of standard nursing care [10].
This presents a dilemma in catheter management regarding the proper securing of
the catheter to facilitate patient mobility while avoiding injuries caused by improper
fixation.
Currently, external fixation of the catheter to the patient’s body surface, such as
the thigh or abdominal wall, is common in clinical practice; however, no unified standard exists for this procedure [11]. Existing evidence has suggested that improper fixation can lead to catheter dislocation, friction, and pressure on the urethral mucosa,
thereby increasing patient discomfort, injury, and infection risk [12,13]. Furthermore,
issues such as the curling and detachment of adhesive tape add to the nursing
workload and material costs [14]. Notably, despite these potential problems, “external catheter fixation to the body surface” has not been explicitly listed as a low-value
nursing practice on either the list developed in China on the basis of clinical nursing
practice guidelines [15] or on lists released through “choosing wisely” campaigns in
countries such as the United States, the Netherlands, and Canada [16–18]. This gap
suggests a lack of rigorous evidence from high-level randomized controlled trials for
evaluating this routine practice [19].
Consequently, this study aimed to systematically assess the practical value of
the external body surface fixation of urinary catheters—a widely used nursing measure—in post-TURP patients through a randomized controlled trial. Guided by the
core defining attributes of low-value care (i.e., care backed by insufficient evidence
of effectiveness, where harm outweighs benefit, care that is not cost-effective, and
that which does not align with patient values and preferences) [20], two strategies,
namely, “external body surface fixation” and “nonexternal body surface fixation”, are
compared in this research. The compar (...truncated)
