Self-discontinuation of Urinary Catheters in a Rural Population

Dartmouth-Hitchcock Medical Center

Overview

The goal of this study is to understand patient satisfaction with two different ways of managing difficulty urinating after gynecologic surgery with a focus on those patients who receive care in a rural area. One common practice is to have an "office catheter removal." This means, if a patient has trouble urinating after surgery and goes home with a foley catheter, they usually have to come back to the clinic within 2-3 days to have the catheter removed and to do a test to see if they can urinate on their own. For some patients, coming back to the clinic so soon after surgery can be difficult, especially for those patients who live far away or are dependent on others for getting to appointments. A second, less common, practice is to have patients remove their own catheter at home, or "self-removal of urinary (Foley) catheter." With self-removal, patients remove their Foley catheter at home, and confirm that they are urinating normally. This approach has been shown to be safe, with similar patient satisfactions, and success, but those studies did not take into account situations where patients may live a rural area and/or travel a long distance to the medical center to receive care. This study is comparing the in-office removal with self-removal. The goal is to find out which option patients prefer, how convenient each approach is, and how well they work. The main goal of this study is to understand patient satisfaction and improve care after surgery.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Conditions

Post-Operative Urinary Retention

At-home Foley Catheter Self-Removal with Passive Void TrialOTHER

Participants will remove their foley catheter at home and perform a passive void trial. They will be instructed to drink fluids and attempt to void within a designated time frame. Instructions and support will be provided to ensure safety and follow-up, including clinic contact if voiding is unsuccessful.

In-Office Foley Catheter Removal and Backfill Void TrialOTHER

Participants will return to clinic for removal of their foley catheter and undergo a backfill void trial. Standard protocols for instillation and assessment of urinary retention will be followed.

Eligibility

Sex: FEMALEMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Adults aged 18 years or older 2. Undergoing gynecologic surgery with planned postoperative trial of void to confirm normal voiding prior to discharge home 3. Willing and able to provide informed consent 4. English-speaking 5. Willing to comply with study procedures, including follow-up phone calls and surveys Exclusion Criteria: 1. Known urinary tract abnormalities (e.g., urethral strictures, neurogenic bladder) that may affect voiding. 2. Diagnosis of voiding dysfunction prior to surgery with need to self-catheterize. 3. Perioperative complication that necessitates indwelling catheter for a specific duration of time. 4. Joint surgeries that would affect ability to comply with study methods (e.g. that necessitates longer inpatient admission or reduces mobility beyond that normal for postop patients after gynecologic surgery) 5. Presence of significant cognitive or physical impairments that limit the ability to comply with study procedures.

Outcomes

Primary Outcomes

Patient Satisfaction with Void Trial Process

Measured using a 0-100 mm visual analog scale (VAS) administered at the 2-week follow-up visit.

Time frame: 2 weeks postoperatively

Secondary Outcomes

Postoperative Urinary Retention

Defined as inability to void ≥200 mL within 30 minutes after backfill (in-office) or failure to void minimum volume within 6 hours post-catheter removal (at-home).

Time frame: within 72 hours postoperatively

Urinary tract infection

Defined by positive urine culture (≥100,000 CFU/mL of uropathogen) and/or clinical diagnosis documented in the chart.

Time frame: Within 30 days postoperatively

Adverse Events Related to Foley Catheter Removal or Void Trial

Includes catheter reinsertion, pain, bleeding, ED visits, unplanned clinic visits, or other provider-documented complications.

Time frame: up to 30 days postoperatively

Healthcare Resource Utilization

Includes the number of MyDH messages, telephone encounters, and unplanned clinic or emergency department visits related to the void trial process, as documented in the electronic medical record.