Early patient removal of urinary catheters after urogynecologic surgery, a randomized trial.
Lauren Tholemeier, Tejal Vanukuru, Bertie Geng et al.
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In 30 seconds
This nonblinded randomized noninferiority trial compared patient removal of urinary catheters at home on postoperative day 1 versus day 3–4 among cis-women who had urinary retention after surgery for stress incontinence and/or pelvic organ prolapse at one academic institution. Among 128 randomized participants, ongoing retention occurred in 14.1% with early removal and 10.9% with standard removal (difference 3.2%; 95% CI, -8.3% to 14.6%), meeting the prespecified noninferiority criterion. Satisfaction was high in both groups, and complication rates and other secondary outcomes did not differ.
Key findings
- Ongoing postoperative retention occurred in 14.1% after day 1 removal versus 10.9% after day 3–4 removal (difference 3.2%).
- The 95% confidence interval for the difference was -8.3% to 14.6%, within the prespecified 15% noninferiority margin.
- Very satisfied responses were similar: 82% with day 1 removal and 81% with day 3–4 removal (P=.63).
- Catheter removal was reported as not difficult by 72% versus 86%, respectively (P=.045); other secondary outcomes and complication rates did not differ.
Why it matters
For patients who fail an immediate postoperative voiding trial, catheter removal at home on postoperative day 1 may avoid several days of catheter use without a higher rate of ongoing retention than removal on day 3–4 in this trial. The findings also indicate high satisfaction with either timing, while the inconclusive subgroup result warrants caution when applying the comparison to concomitant anti-incontinence procedures.
What to keep in mind
The trial was nonblinded and conducted at a single academic institution. Noninferiority was inconclusive in the subgroup undergoing concomitant anti-incontinence procedures.