Self-discontinuation of a Transurethral Catheter

Postoperative urinary retention (POUR) is a common issue following urogynecologic surgery,
with incidence rates of 1.4-43%. The wide range of incidence is due to the lack of a
standardized definition of POUR. Generally speaking, POUR can be characterized by any
impairment in bladder emptying following surgery. While the gold standard for assessing
voiding function remains measurement of a postvoid residual (PVR), there are many voiding
trial (VT) methods being used across institutions.

Historically, the most widely accepted postoperative VT for the assessment of voiding
function was the backfill method. An alternative assessment of voiding function is the
spontaneous VT, where the indwelling catheter is removed and a patient is asked to void
spontaneously when a patient has the urge. It is controversial which of these methods are
superior, and studies are conflicted. Nevertheless, both of these methods were studied in a
clinical setting, and we lack information on self-discontinuation efficacy at home.

Managing an indwelling urinary catheter and returning to the outpatient clinic only a week
after discharge from the hospital can be overwhelming for patients and their involved
caregivers. Given the low incidence of POUR at one-week postoperative and patient
dissatisfaction with urinary catheter management, home self-removal of indwelling urinary
catheters is an important topic of investigation.

We are trying to compare the incidence of POUR between self-discontinuation and
office-discontinuation of urinary catheters. The results of this study could impact on the
decision regarding catheter use following inpatient pelvic organ prolapse surgery.

Inclusion Criteria:

- Undergoing vaginal vault suspension or robot-assisted laparoscopic sacrocolpopexy by a
physician at Cincinnati Urogynecology Associates, TriHealth Inc.for the treatment of
pelvic organ prolapse

- Failed voiding trial prior to discharge

- Concomitant procedures such as hysterectomy, suburethral sling, anterior or posterior
colporrhaphy, bilateral salpingectomy or salpingooophorectomy

Exclusion Criteria:

- physical or mental impairment that would affect the subject's ability to self-remove
indwelling urinary catheter, including patient's with Multiple Sclerosis, Dementia,
Parkinsonism, or those who have impaired mobility or are wheelchair bound

- Bladder injury, fistula repair or other need for prolonged catheterization