Can a patient refuse insertion of urinary catheter for the duration of a facelift? If yes, when/why? If no, when/why?

This should be discussed with the patient prior to the procedure.  It should be part of the consent process. It may be possible to avoid it for shorter cases, around 3 hours, but anything longer would be too uncomfortable. 

Typically urinary catheters are placed if a surgery is expected to last over 4 hours. How long your surgery is expected to take depends on the technique and extent of dissection, as well as the surgeon. The amount of time it takes does not in and of itself make the surgeon good or bad. (Patients don't thank their surgeons for being fast. They thank them for delivering excellent results.) Also, they are typically place by the nurse after the patient is asleep, while the patient is on the operating room table. This is done for your own comfort, as you are correct it can be uncomfortable while awake. It strikes me as odd that you feel it is an invasion of your privacy because it is "done in an area where not a lot of people see". I don't know if you are referring the the body area as a place people don't see, or the operating room. Either way, it is actually to protect your privacy that it is done without a lot of people around to watch. Usually the nurse in the OR, male or female, is the one to insert it, and this is something they do daily for any surgery where it is indicated. The catheter is often removed before the patient wakes up, again for comfort. I do understand for the patient it is a private and sensitive matter, but the nurse performing the procedure is trained to do this as part of his/her job as a medical professional. The catheter serves a purpose, and is part of your surgical care, the same way inserting an IV, placing blood pressure cuff, protecting your body from heat loss during surgery, placing sequential compression devices to your legs to prevent blood clots, etc, are normal parts of your peri-operative care, and do not require individual consent forms. Whether a male or female inserts the catheter simply depends on who is staffing the operating room that day. If you have a preference, you can always ask the surgery center to make special accomodations. For example, I have had patients undergoing labiaplasty that request an all female team. I want my patients to be comfortable and as long as we know in advance, we are able to book all female staff members for those cases. If your surgeon feels the surgery will be long enough to warrant a catheter, it goes against your best interests to refuse it (unless there are other extenuating circumstances), and the surgeon will have to decide whether or not to proceed.

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation. I would recommend discussing this with your surgeon prior to surgery.  In my practice, I do use a catheter for a facelift procedure.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Thank you for your question.The length of the procedure is what determines if a urinary catheter is inserted during the surgery. As a general rule, if the procedure will last longer than 3 hours it is a good idea to place a catheter. In most cases the catheter is place once you are under anesthesia in the privacy of the operating room. 

Facelift are usually long surgeries (about 5 hours)  that requires insertion of foley cathethers to drain the urine during the procedure. If the urine is not drained and it accumulates, it could cause significant urinary problems secondary to the severe distention of the bladder with urine. Therefore, it is a medical standard to insert a urinary catheter (foley) when a surgical procedure lasts more than 3 horus. Asking for not inserting a foley catheter in the bladder to a doctor when medically necessary due to "privacy concerns" is like asking a doctor not to use stitches to close a facelift due to similar reasons ( so people "don't see the stitches") 

The simple answer is "yes", you can refuse.  Although placement of a foley catheter is more the exception than the norm during a facelift in my practice, it can be a good idea for longer cases.  A full bladder can account for an elevated heart rate or blood pressure, particularly toward the end of a case.  Your Surgeon will only want to do what is best for you, but it is always your right to refuse. 

The use of a urinary catheter is standard for surgeries over 4 hours or so.  Your bladder is only made to hold just so much and depending upon the surgeon and the extent of the surgery, your procedure can take anywhere from 4 to 8 hours or more.  The longer period of time will fill your bladder beyond "normal limits" and may distend the tissue enough so that urinating on your own after surgery becomes impossible.  In that case, as catheter has to be placed while you're awake and is often left for 1-3 days. This obviously creates much more difficulty for the patient.  Further, some anesthesia professionals like to use the urinary flow in the catheter to balance fluids given to the patient during surgery.  However, you are certainly within your rights to request a person of your gender to place the catheter.

A urinary catheter is used when the length of an operation exceeds a certain amount of time, which varies from surgeon to surgeon.  Your body continues to make urine and fill the bladder during surgery, especially with generous IV fluid administration.  Each individual plastic surgeon has a different amount of time that he/she feels comfortable to have the patient under anesthesia without a catheter.  In addition, if the patient wakes up from anesthesia with a full bladder, the patient may have urgency to get up to a restroom, which can increase their blood pressure and bleeding risk.  Many surgeons are able to perform a facelift in an amount of time that they feel comfortable avoiding placement of a urinary catheter.  However, I would not fault a plastic surgeon who wishes to use a catheter routinely for this operation.  I would recommend discussing your concerns with the plastic surgeons you consult with for facelift to find a surgeon that you feel most comfortable with to perform this operation and take into account your preferences.
Ziyad Hammoudeh, MD

This is a good question. Many procedures are four hours in length or longer.  The need for a catheter depends on the length of the procedure as well as communicating with anesthesia as to how much fluid the patient is going to receive intravenously. This is something that can be discussed with your physician, and if it is something you're uncomfortable with, the length of the procedures can be shortened by limiting multiple procedures at once.
I wish you good luck!!

 A urinary catheter is totally unnecessary for facelift procedure. In our practice, a facelift takes between 2 to 3 hours to perform. Urinary catheters are only used for surgeries that last over five hours. Fluid management by your anesthesiologist would be helpful to prevent a urinary catheter. If your bladder becomes too full during a surgical procedure, your blood pressure will rise which will increase bleeding potential.