Assessing Health Care Utilization and Feasibility of Transurethral Catheter Self-Discontinuation
Authors: Davenport Abigail , Li Yi , Melvin Emily , Arcaz Arthur , Lefbom Lucie , Iglesia Cheryl B. , Dieter Alexis A. 
Published: March 2023

OBJECTIVE:
To compare the rates of health care utilization (office messages or calls, office visits, and emergency department [ED] visits) and postoperative complications within 30 days after surgery between patients with successful voiding trials on postoperative day 0 and those with unsuccessful voiding trials on postoperative day 0 and between patients with successful and unsuccessful voiding trials on postoperative day 1. Secondary objectives were to identify risk factors for unsuccessful voiding trials on postoperative days 0 and 1 and to explore the feasibility of catheter self-discontinuation by assessing for any complications associated with at-home catheter self-discontinuation on postoperative day 1.

METHODS:
This study was a prospective observational cohort study of women undergoing outpatient urogynecologic or minimally invasive gynecologic surgery for benign indications at one academic practice from August 2021 to January 2022. Enrolled patients with unsuccessful immediate postoperative voiding trials on postoperative day 0 performed catheter self-discontinuation by cutting their catheter tubing per instructions at 6 am on postoperative day 1 and recording their voided volumes over the subsequent 6 hours. Patients who voided less than 150 mL underwent a repeat voiding trial in the office. Demographics, medical history, perioperative outcomes, and number of postoperative office calls or visits and ED visits within 30 days were collected.

RESULTS:
Of the 140 patients who met inclusion criteria, 50 patients (35.7%) had unsuccessful voiding trials on postoperative day 0, and 48 of these 50 (96%) performed catheter self-discontinuation on postoperative day 1. Two patients did not perform catheter self-discontinuation on postoperative day 1: One had her catheter removed in the ED on postoperative day 0 during an ED visit for pain control, and the other performed catheter self-discontinuation off protocol at home on postoperative day 0. There were no adverse events associated with at-home postoperative day 1 catheter self-discontinuation. Of the 48 patients who performed catheter self-discontinuation on postoperative day 1, 81.3% (95% CI 68.1–89.8%) had successful postoperative day 1 at-home voiding trials, and 94.5% (95% CI 83.1–98.6%) of those with successful voiding trials did not require additional catheterization. Patients with unsuccessful postoperative day 0 voiding trials had more office calls and messages (3 vs 2, P<.001) and those with unsuccessful postoperative day 1 voiding trials attended more office visits (2 vs 1, P<.001) compared with those with successful postoperative day 0 or 1 voiding trials, respectively. There was no difference in ED visits or postoperative complications between patients with successful voiding trials on postoperative day 0 or 1 and those with unsuccessful voiding trials on postoperative day 0 or 1. Patients with unsuccessful postoperative day 0 voiding trials were older and more likely to have undergone vaginal hysterectomy or prolapse repair than those with successful postoperative day 0 voiding trials. Patients with unsuccessful postoperative day 1 voiding trials were older than those with successful postoperative day 1 voiding trials.

CONCLUSION:
Catheter self-discontinuation is a feasible alternative to in-office voiding trials on postoperative day 1 after advanced benign gynecologic and urogynecologic surgery, with low rates of subsequent retention and no adverse events seen in our pilot study.