Postop Self-Removal of Foley Boosts Patient Satisfaction, Curbs Office Visits

By Marilynn Larkin

October 19, 2019

NEW YORK (Reuters Health) - In patients with post-operative urinary retention after pelvic reconstructive surgery, self-removal of a transurethral catheter is noninferior to office-based removal and leads to fewer office visits and a better patient experience, researchers say.

"This study is practice changing," Dr. Abigail Shatkin-Margolis of Good Samaritan Hospital TriHealth in Cincinnati, told Reuters Health by email. "Postoperative urinary retention is a common problem that not only requires a lot of resources to manage, but also is often the most frustrating part of postoperative care for the patient. We sought to find a safe and effective management strategy that appeased our patients and utilized fewer resources."

Dr. Shatkin-Margolis and colleagues randomized 157 women to self-removal or office removal one week after surgery. The average age was 61; most were white; and most had stage II or stage III prolapse as defined by the pelvic organ prolapse quantification scale. Demographic characteristics and surgeries performed were similar between the groups.

At the two-week visit, all patients completed a questionnaire and visual analog scale (VAS) regarding their experience with catheter care. Any participant still requiring catheterization at two weeks underwent a retrograde fill voiding trial. Those who did not pass the trial were taught clean intermittent catheterization.

As reported online October 8 in Obstetrics and Gynecology, 11 women in each group experienced postoperative urinary retention at one week - sufficient power to establish noninferiority.

However, significantly fewer patient encounters occurred with self-discontinuation (53.8% vs.100%), and those patients also had better VAS scores with regard to pain, ease, disruption, and likelihood to use the same method again.

The rate of urinary tract infection was high, but with no difference between groups (59.0% self-discontinuation vs. 66.7% office discontinuation). Residual volume at two weeks, recurrent postoperative urinary retention, and catheter use duration were also similar.

Dr. Shatkin-Margolis said, "This study provides evidence that self-discontinuation may decrease health expenditures and increase patient satisfaction, without any additional risk."

Dr. Fara Bellows, a urologist at The Ohio State University Wexner Medical Center in Columbus, commented by email, "We commonly encourage patients, especially those who live far from the office, to remove their catheters at home, not just after urogynecologic procedures, but also after resection of a bladder tumor. Usually, it is an uneventful process."

"We also commonly see patients after a variety of non-urologic operations with post-operative urinary retention, and that particular population would likely benefit from implementation of a self-removal protocol," she told Reuters Health.

"It is essential that the patient is trustworthy to be able to self-assess their ability to adequately empty their bladder, and communicate any concerns to caregivers or office staff if needed," she said. "In the right patient, catheter self-removal is efficient and practical for both clinicians and patients."

Dr. Tanaka Dune, a urogynecologist at NewYork-Presbyterian and Weill Cornell Medicine in New York City, said in an email to Reuters Health, "The typical practice once urinary retention is noted, is the application of post-operative intermittent self-catheterization for the patient."

"As this team has officially studied the use of indwelling catheters for use in post-operative urinary retention, they have advanced our knowledge of the indwelling catheter as another viable post-operative urinary retention treatment option," she noted. "This is important, as not every patient can be taught how to self-catheterize."

"The reduction of post-operative interactions is also key," she said, "as there is a potential to reduce anxiety and worry in patients and clinicians."

"Though the study revealed no difference in urinary tract infection rates between the two groups, it was not powered to find a difference," she noted.

Nonetheless, she said, "Clinicians certainly should continue, to their best ability, to know their individual patient pre-operatively and to try to anticipate potential limitations patients may have with their ability to self-catheterize, if needed post-operatively."

Further, she added, "they should be aware of the capabilities patients have and continue to encourage these abilities!"


Obstet Gynecol 2019.