LAUSR

BACKGROUND Data on the experience that women undergoing urogynecologic surgery have with postoperative catheterization are severely limited. As the importance of our patients' perioperative experience becomes more valued, assessing the burden of postoperative catheterization, which has not yet been performed, is increasingly needed. OBJECTIVE The aim of this study is to compare catheter burden in women who self-selected use of an indwelling Foley catheter versus clean intermittent self-catheterization for voiding dysfunction following reconstructive pelvic surgery. STUDY DESIGN This is a nested study within a non-blinded randomized controlled trial of two different voiding trial protocols conducted from 3/2017 to 10/2017. Women undergoing pelvic organ prolapse and/or stress urinary incontinence surgery who were English speaking and 18 years or older with a preoperative postvoid residual <100 mL were included. Participants who failed their voiding trial were discharged with an indwelling Foley catheter or self-catheterization per participant preference. Our primary outcome was catheter burden at one week after surgery, which was assessed by the Short-Term Catheter Burden Questionnaire, which is a validated 6-item survey comprised of two 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 two 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 (51%) failed their voiding trial, and, of those, 47 (61%) were discharged home with an indwelling catheter and 30 (39%) with self-catheterization. Baseline demographics were similar except that women choosing an indwelling Foley catheter were older (62 ± 11 vs. 55 ± 11 years, p <0.01). There were no significant differences between indwelling Foley catheter and self-catheterization in total catheter burden score (18 ± 5 vs. 18 ± 6, p=0.77), difficulty of use subscale score (8 ± 3 vs. 9 ± 3, p=0.20), or embarrassment subscale score (10 ± 4 vs. 9 ± 4, p=0.12). For secondary outcomes, there were no significant differences in rate of urinary tract infection (23% indwelling vs. 30% self-catheterization, p=0.60). Consistent with study protocol, women discharged with an indwelling Foley catheter did have more postoperative clinic visits (2 ± 1 vs. 1 ± 1, p<0.01), and those discharged with self-catheterization had more postoperative phone calls (2 ± 3 vs. 5 ± 3, p<0.01). Otherwise there was no significant difference in non-voiding related clinic visits (1±1 for indwelling and self-catheterization, p=0.15). or postoperative phone calls (1±2 indwelling vs 2±3 self-catheterization, p=0.31). CONCLUSIONS In women using either an indwelling Foley catheter or clean intermittent self-catheterization for management of postoperative voiding dysfunction following pelvic reconstructive surgery, there were no differences in difficulty of use, embarrassment, or overall catheter burden. There were also no differences in non-voiding related postoperative phone calls or clinic visits, with similar rates of urinary tract infection between the two groups.