(Poster 51) Home Foley Catheter Removal for Urogynecology Post-operative Voiding Retention

Objectives: Our primary aim was to determine if home Foley removal for urogynecology patients with postoperative urinary retention is a safe alternative to a backfill voiding trial in the office, as measured by the rates of urinary tract-related postoperative complications and failed office or home voiding trial. Our secondary aims were to assess healthcare utilization and patient satisfaction.

Methods: A universal protocol was implemented in October 2024 for patients with postoperative urinary retention following urogynecologic surgery at an academic tertiary care center, as part of a quality improvement initiative. Pre-implementation, patients who failed a backfill voiding trial (VT) in the postoperative care unit (PACU) were offered continuous intermittent catheterization (CIC) or placement of Foley and repeat backfill VT in the office. With the new protocol, patients who chose Foley placement were provided with a handout and verbal instructions for Foley removal and home VT. Surgeons and nursing staff were educated on the protocol. Retrospective cohorts of patients who failed PACU VT from August – September 2024 (pre-implementation) and November – December 2024 (post-implementation) were compared, with a 1-month washout period.

The co-primary outcomes of rates of urinary tract-related postoperative complications and failed office or home VT were abstracted from the medical record. Additional outcomes included the number of postoperative messages or calls to the office, office visits, and emergency department (ED) visits. Patients who elected for home Foley removal were asked to indicate their satisfaction with the removal process on a 10-point visual analog scale and provide comments. p-values were calculated with Mann-Whitney U tests.

Results: The pre- and post-implementation cohorts included 12 and 20 patients respectively. Median age was 62 years (34 – 86). Most patients were white and overweight with stage 3 prolapse with no differences before and after implementation. All procedures were performed under general anesthesia and there were no intraoperative complications.

Five (42%) pre-implementation patients and 3 (15%) post-implementation patients elected for CIC. The rate of office voiding trial failure was 29% (2/7) pre-implementation; the rate of home voiding trial failure was 25% (4/16) post-implementation. There were no urinary tract-related postoperative complications in either group.

While both cohorts had similar numbers of office and ED visits, there were significantly more patient-initiated messages or calls pre-implementation (Table 1). Fourteen home Foley removal patients completed the satisfaction scale; the median score was 10 (interquartile range 7 – 10), indicating “extreme satisfaction”. Survey comments were overwhelmingly positive.

Conclusions: Home Foley removal is a safe alternative to office void trial for postoperative urinary retention in urogynecology. Patients who remove their Foley at home have equal or fewer points of contact with the healthcare system and report high rates of satisfaction with the process.

Figure legend: IQR, interquartile range.