Home vs. Office Foley Catheter Removal in Women With Voiding Difficulty Following Pelvic Reconstructive Surgery

While in the hospital, all women who undergo surgery for pelvic organ prolapse and/or urinary
incontinence will have a voiding trial to evaluate whether their bladder is working as it
should. A voiding trial is when you are asked to urinate when you feel the desire to do so,
sometimes, a physician may fill your bladder with water prior to removing the Foley catheter.
This allows the physician to know exactly how much is left in your bladder. This evaluation
will occur in the recovery room for subjects who have a same-day procedure. Those who are
admitted to the hospital will have the voiding trial before their discharge typically on
postoperative day 1. Those who fail the voiding trial will be diagnosed with urinary
retention (bladder not working as well as we expect) and will be discharged home with a Foley
catheter. If you agree to participate you will be randomly assigned to one of two groups:
Subjects in the one group will remove their indwelling Foley catheter at home and will have a
voiding assessment done over the telephone based on their self-reported force of urinary
stream. The other group will follow up in the Uro/Gynecology office for Foley catheter
removal and voiding trial. Which group you are assigned to will be random. You have an equal
chance to be assigned to either group. It is important to note that outside of the study,
physicians choose to manage patients one of these two ways. Removal of the Foley catheter at
home is not experimental, and often done in these situations.

Both groups of women will be given instructions on urinary catheter and bag (where the urine
drains into) management. Prior to discharge, every subject from the home removal group as
well as their significant other/caregiver/family member if applicable will receive a
standardized education session and written and illustrated instructions on Foley catheter
removal. This teaching will be done by an experienced and qualified nurse. You will be
provided with the syringe for catheter removal, urine collection pan, and a diary to record
their voiding quality and quantity. Both groups of women will have the catheter removal in 2
days. This will have to be delayed up to 4 days due to weekends if the procedure is performed
on a Thursday or Friday.

In the home removal group, you and your significant other/caregiver/family member will be
instructed to remove the Foley catheter at the pre-set date prior to 8 am. The research nurse
or Uro/Gynecology (uro/Gyn) office nurse will contact contact 4 hours after removal. Voiding
function will be evaluated by your self reported Force of Stream (FOS). This means the force
that urine is expelled from your body compared to normal. A report of FOS of at least 5 on a
0-10 has been shown to be a safe and effective method of assessing voiding function.
Additionally, volume of each void will be measured by you and reported to the research nurse
and/or the UroGyn office nurse. If there is evidence of voiding difficulty as indicated by a
FOS below 5/10, the research and/or UroGyn nurse will instruct you to follow up in the office
immediately for clean intermittent self-catheterization (CISC) teaching. This means inserting
a small, thin plastic tube in your urethra (opening of the body where urine is expelled). If
your voiding pattern qualifies as adequate, you will not require an office visit for voiding
assessment. However, you will be instructed to contact the office if you feel full after
voiding, are voiding less than 2 ounces or 50 mL each time and more often than every 30
minutes, or feel pressure and discomfort in their lower abdomen.

Women in the other group will return to the office in 2-4 days and will undergo a voiding
trial via retrograde fill with 10 ounces (300 mL) of normal saline or until your bladder
capacity is reached. This means that a catheter will be inserted in your urethra and normal
saline will be put in your bladder via a large syringe that acts as a funnel. You would be
considered to have failed the voiding trial and be taught clean intermittent
self-catheterization if you do not void 5 ounces (150 mL) within an hour or you become too
uncomfortable with the bladder fullness, and your postvoid residual volume is greater than
150 mL. The residual volume is determined by a portable ultrasound like machine via an
external probe which is scanned over your lower pelvic area.

At the routine 2 - 4 week post-operative visit, both groups will receive a 5 question survey
asking about your experience with removal of the Foley catheter.

Inclusion Criteria:

- Women with post-operative voiding difficulty requiring catheterization after pelvic
reconstructive surgery or surgery for urinary incontinency.

Exclusion Criteria:

- A Pelvic Reconstructive Surgery/Urogynecology fellow or attending physician may deem
patients ineligible based on patients post-operative voiding trial.