Advertisement

Catheter burden following urogynecologic surgery

      Background

      Data on the experience that women who undergo urogynecologic surgery have with postoperative catheterization are severely limited. As the importance of our patients’ perioperative experience becomes more valued, assessment of the burden of postoperative catheterization, which has not yet been performed, is increasingly needed.

      Objective

      The aim of this study was to compare catheter burden in women who self-selected use of an indwelling Foley catheter vs clean intermittent self-catheterization for voiding dysfunction after reconstructive pelvic surgery.

      Study Design

      This is a nested study within a nonblinded randomized controlled trial of 2 different voiding trial protocols that was conducted from March to October 2017. Women who underwent pelvic organ prolapse and/or stress urinary incontinence surgery who were English speaking and ≥18 years old with a preoperative postvoid residual <100 mL were included. Participants who did not pass their voiding trial were discharged with an indwelling Foley catheter or self-catheterization per participant preference. Our primary outcome was catheter burden at 1 week after surgery assessed by the Short-Term Catheter Burden Questionnaire, which is a validated 6-item survey comprised of 2 subscales: difficulty of use and embarrassment. Scores range from 3–15 with higher scores indicating greater difficulty and/or embarrassment, and the sum of the 2 subscale scores measures total catheter burden with a higher score indicating greater burden. Secondary outcomes included the rate of urinary tract infection, the number of postoperative clinic visits, and the number of postoperative phone calls.

      Results

      Of 150 participants, 77 women (51%) did not pass their voiding trial; of those, 47 women (61%) were discharged home with an indwelling catheter and 30 women (39%) with self-catheterization. Baseline demographics were similar, except that women who chose an indwelling Foley catheter were older (62±11 vs 55±11 years; P<.01). There were no significant differences between indwelling Foley catheter and self-catheterization in total catheter burden score (18±5 vs 18±6; P=.77), difficulty of use subscale score (8±3 vs 9±3; P=.20), or embarrassment subscale score (10±4 vs 9±4; P=.12). For secondary outcomes, there were no significant differences in rate of urinary tract infection (23% indwelling vs 30% self-catheterization; P=.60). Consistent with study protocol, women who were discharged with an indwelling Foley catheter did have more postoperative clinic visits (2±1 vs 1±1 visits; P<.01), and those women who were discharged with self-catheterization had more postoperative phone calls (2±3 vs 5±3 phone calls; P<.01). Otherwise there was no significant difference in nonvoiding-related clinic visits (1±1 visits for indwelling and self-catheterization; P=.15) or postoperative phone calls (1±2 indwelling vs 2±3 self-catheterization calls; P=.31).

      Conclusion

      In women who used either an indwelling Foley catheter or clean intermittent self-catheterization for management of postoperative voiding dysfunction after pelvic reconstructive surgery, there were no differences in difficulty of use, embarrassment, or overall catheter burden. There were also no differences in nonvoiding-related postoperative phone calls or clinic visits, with similar rates of urinary tract infection between the 2 groups.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Book N.M.
        • Novi B.
        • Novi J.M.
        • Pulvino J.Q.
        Postoperative voiding dysfunction following posterior colporrhaphy.
        Female Pelvic Med Reconstr Surg. 2012; 18: 32-34
        • Geller E.J.
        • Hankins K.J.
        • Parnell B.A.
        • Robinson B.L.
        • Dunivan G.C.
        Diagnostic accuracy of retrograde and spontaneous voiding trials for postoperative voiding dysfunction: a randomized controlled trial.
        Obstet Gynecol. 2011; 118: 637-642
        • Myers E.M.
        • Matthews C.A.
        • Crane A.K.
        • Connolly A.
        • Wu J.M.
        • Geller E.J.
        Two techniques for assessing postoperative voiding function, a randomized trial.
        Int Urogynecol J. 2017; 28: 1567-1572
        • Tunitsky-Bitton E.
        • Murphy A.
        • Barber M.D.
        • Goldman H.B.
        • Vasavada S.
        • Jelovsek J.E.
        Assessment of voiding after sling: a randomized trial of 2 methods of postoperative catheter management after midurethral sling surgery for stress urinary incontinence in women.
        Am J Obstet Gynecol. 2015; 212: 597.e1-597.e9
        • Turner L.C.
        • Kantartzis K.
        • Shepherd J.P.
        Predictors of postoperative acute urinary retention in women undergoing minimally invasive sacral colpopexy.
        Female Pelvic Med Reconstr Surg. 2015; 21: 39-42
        • Williams K.S.
        • Pilkinton M.L.
        • Shalom D.F.
        • Winkler H.A.
        A randomized controlled trial comparing two voiding trials after midurethral sling with or without colporrhaphy.
        Int Urogynecol J. 2018; ([Epub ahead of print])https://doi.org/10.1007/s00192-018-3783-3
        • Yune J.J.
        • Cheng J.W.
        • Wagner H.
        • Kim J.
        • Hardesty J.S.
        • Siddighi S.
        Postoperative urinary retention after pelvic organ prolapse repair: vaginal versus robotic transabdominal approach.
        Neurourol Urodyn. 2018; 37: 1794-1800
        • Elkadry E.A.
        • Kenton K.S.
        • FitzGerald M.P.
        • Shott S.
        • Brubaker L.
        Patient-selected goals: a new perspective on surgical outcome.
        Am J Obstet Gynecol. 2003; 189: 1551-1558
        • Carpenter J.S.
        • Heit M.
        • Rand K.L.
        Development and psychometric properties of a measure of catheter burden with bladder drainage after pelvic reconstructive surgery.
        Neurourol Urodyn. 2017; 36: 1140-1146
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • McDermott C.D.
        • Ryan V.
        • Pulver A.
        • Boutet M.
        Postoperative voiding dysfunction: the preferred method for catheterization.
        Female Pelvic Med Reconstr Surg. 2019; 25: 56-62
        • Kenton K.
        • Pham T.
        • Mueller E.
        • Brubaker L.
        Patient preparedness: an important predictor of surgical outcome.
        Am J Obstet Gynecol. 2007; 197: 654.e1-654.e6
        • Dieter A.A.
        • Amundsen C.L.
        • Edenfield A.L.
        • et al.
        Oral antibiotics to prevent postoperative urinary tract infection: a randomized controlled trial.
        Obstet Gynecol. 2014; 123: 96-103
        • Chung C.P.
        • Kuehl T.J.
        • Harris S.K.
        • et al.
        Incidence and risk factors of postoperative urinary tract infection after uterosacral ligament suspension.
        Int Urogynecol J. 2012; 23: 947-950
        • Dieter A.A.
        • Amundsen C.L.
        • Visco A.G.
        • Siddiqui N.Y.
        Treatment for urinary tract infection after midurethral sling: a retrospective study comparing patients who receive short-term postoperative catheterization and patients who pass a void trial on the day of surgery.
        Female Pelvic Med Reconstr Surg. 2012; 18: 175-178
        • Rogers R.G.
        • Kammerer-Doak D.
        • Olsen A.
        • et al.
        A randomized, double-blind, placebo-controlled comparison of the effect of nitrofurantoin monohydrate macrocrystals on the development of urinary tract infections after surgery for pelvic organ prolapse and/or stress urinary incontinence with suprapubic catheterization.
        Am J Obstet Gynecol. 2004; 191: 182-187
        • Jannelli M.L.
        • Wu J.M.
        • Plunkett L.W.
        • Williams K.S.
        • Visco A.G.
        A randomized controlled trial of clean intermittent self-catheterization versus suprapubic catheterization after urogynecologic surgery.
        Am J Obstet Gynecol. 2007; 197: 72.e1-72.e4
        • Hakvoort R.A.
        • Thijs S.D.
        • Bouwmeester F.W.
        • et al.
        Comparing clean intermittent catheterisation and transurethral indwelling catheterisation for incomplete voiding after vaginal prolapse surgery: a multicentre randomised trial.
        BJOG. 2011; 118: 1055-1060
        • Hakvoort R.A.
        • Nieuwkerk P.T.
        • Burger M.P.
        • Emanuel M.H.
        • Roovers J.P.
        Patient preferences for clean intermittent catheterisation and transurethral indwelling catheterisation for treatment of abnormal post-void residual bladder volume after vaginal prolapse surgery.
        BJOG. 2011; 118: 1324-1328
        • Takase-Sanchez M.M.
        • Thompson J.C.
        • Hale D.S.
        • Heit M.H.
        Suprapubic versus transurethral bladder drainage following reconstructive pelvic surgery: a comparison of patient satisfaction and quality of life.
        Int Urogynecol J. 2017; 28: 721-728