To assess patient satisfaction with location of indwelling catheter removal placed for urinary retention after urogynecologic surgery.
All adult women who were diagnosed with urinary retention requiring post-operative indwelling catheter insertion after undergoing surgery for urinary incontinence and/or pelvic organ prolapse were eligible for this randomized controlled study. They were randomly assigned to catheter removal at home or in the office. Those who were randomized to home removal were taught how to remove the catheter prior to discharge, and discharged home with written instructions, a voiding hat, and 10 mL syringe. All patients had their catheter removed 2-4 days after discharge. Those patients who were allocated to home removal were contacted in the afternoon by the office nurse. Subjects who graded their force of urine stream 5, on a scale of 0-10, were considered to have safely passed their voiding trial. For patients randomized to the office removal group, the voiding trial consisted of retrograde filling the bladder to maximum they could tolerate up to 300 mL. Urinating >50% of instilled volume was considered successful. Those who were unsuccessful in either group had catheter reinsertion or self-catheterization training in the office. Primary study outcome was patient satisfaction, measured based on patients' response to a question "How satisfied were you with the overall removal process of the catheter?". A visual analogue scale was created to assess patient satisfaction and 4 secondary outcomes. A sample size of 40 participants per group were needed to detect a 10 mm difference in satisfaction between groups on the visual analogue scale. This calculation provided 80% power and an alpha of 0.05. Final number accounted for 10% loss to follow up. We compared the baseline characteristics including urodynamic parameters, relevant perioperative indices, and patient satisfaction between the groups.
Of the 78 women enrolled in the study, 38 (48.7%) removed their catheter at home and 40 (51.3%) had an office visit for catheter removal. Median and interquartile range (IQR) for age, vaginal parity, and body mass index (BMI) were 60 (49-72) years, 2 (2-3), and 28 (24-32) kg/m2, respectively, in the overall sample. Groups did not differ significantly in age, vaginal parity, body mass index, prior surgical history, or type of concomitant procedures. Patient satisfaction was comparable between the groups, with a median score (IQR) of 95 (87-100) in the home catheter removal group and 95 (80-98) in the office catheter removal group (p=0.52). Voiding trial pass rate was similar between women who underwent home (83.8%) versus office (72.5%) catheter removal (p=0.23). No participants in either group had to emergently come into the office or hospital due to inadequate voiding afterwards. Within 30 days post operatively, a lower proportion of women in the home catheter removal group (8.3%) had urinary tract infection, compared to patients in the office catheter removal group (26.3%) (p=0.04).
In women with urinary retention after urogynecologic surgery, there is no difference in satisfaction with regards to location of indwelling catheter removal when comparing home and office.
American journal of obstetrics and gynecology. 2023 Jun 15 [Epub ahead of print]
Patrick Popiel, Christina Swallow, Jennie Eunsook Choi, Keisha Jones, Xiao Xu, Oz Harmanli
Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York. Electronic address: ., HealthPartners, St. Paul, Minnesota., Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut., Department of Obstetrics and Gynecology, Baystate Medical Center, University of Massachusetts Medical School, Springfield, Massachusetts., Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut; Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York.