Background <p>Indwelling pleural catheters (IPCs) are used to manage refractory pleural effusions (PEs), including malignant (MPE) and non-malignant pleural effusions (NMPE). This study evaluates IPC efficacy and safety, focusing on pleurodesis success, symptom relief, recurrence, survival, and complications.</p> Methods <p>A prospective cohort study of 74 patients (62 MPE, 12 NMPE) who underwent IPC insertion between 2019 and 2024 at a tertiary teaching hospital. Patients were followed for at least 12 months. The primary outcomes were symptom relief and successful pleurodesis. Secondary outcomes included the duration of IPC placement, time to pleurodesis, recurrence rates, complication rates, and overall survival.</p> Results <p>Pleurodesis was achieved in 32% of patients, lower in MPEs (28%) than NMPEs (50%) (<i>p</i> = 0.02). Mean IPC duration was 10.2 weeks (MPE: 10.7, NMPE: 7.5 weeks). Symptom relief was reported in 85%, with no significant difference between groups. Recurrence occurred in 3% of patients, all within the NMPE cases. Complications included catheter blockage (16%), chest pain (13%), loculation (9%), and pleural infection (9%), with no significant differences between groups. MPE patients had significantly lower survival at 3, 6, and 12 months (<i>p</i> &lt; 0.05). IPC duration was not linked to survival (<i>p</i> = 0.93).</p> Conclusion <p>IPCs provide symptom relief and facilitate pleurodesis, though success is lower in MPEs. Complications are comparable between groups, supporting IPCs as a management option for both MPE and NMPE. Further research is needed to optimize IPC use and identify predictors of pleurodesis success.</p> Trial registration <p>Retrospectively registered.</p> Graphical Abstract <p></p>