Early Patient Removal of Urinary Catheter After Urogynecologic Surgery, a Randomized Trial

INTRODUCTION: A previous study determined that home removal of indwelling urinary catheters on postoperative days (POD) 3–4 was noninferior to office removal in terms of early retention rates. Home removal was also shown to have high patient satisfaction. Home removal of indwelling urinary catheters for patients with postoperative urinary retention was subsequently implemented in our practice, but optimal timing of catheter removal was unclear. OBJECTIVE: To compare early postoperative retention between early home catheter removal (POD1) and standard home removal (POD3–4). Secondary outcomes were patient satisfaction, complication rates, and healthcare utilization. METHODS: This was a non-blinded randomized controlled noninferiority trial of women who underwent surgery for stress incontinence and/or pelvic organ prolapse from June 2024 to September 2025. Participants who failed a postoperative voiding trial were randomized 1:1 to early home removal on POD1 versus standard home removal on POD3–4, with POD4 assigned to Thursday cases to allow for Monday removal. Instructions were otherwise the same for both groups: remove the catheter at 7 AM on the assigned date, drink two glasses of water, and notify the clinic if unable to void after 5 hours to schedule a repeat void trial in the office. Exclusion criteria were preoperative voiding dysfunction (chronic retention or postvoid residual >150 mL), or plan for prolonged postoperative catheterization. Our primary outcome was rate of early postoperative retention, defined as inability to void after home catheter removal and needing continued catheter use. At 80% power and α=0.05, we needed 116 participants (58 per group) to detect a non-inferiority margin of 15%. We planned to enroll 128 participants to allow for a 10% dropout rate. Secondary outcomes were patient satisfaction (assessed with a 2-week phone call), complication rates, and healthcare utilization (patient messages, calls, and office visits). RESULTS: At the time of abstract submission, primary outcome data for 122 participants were available (61 participants per group) and complete data available for 111 participants. We anticipate that complete data will be available for all 128 subjects by the time of presentation. The POD1 and POD3–4 groups were similar in demographic characteristics (Table 1). The rate of early postoperative retention was 13.1% in the POD1 group versus 10.1% the POD3–4 group. The 95% confidence interval of the difference between the two groups met the a priori acceptable limit of 15% (−8.5%, 14.4%), thus meeting criteria for non-inferiority. The majority of both groups reported that catheter removal was “not difficult,” but this was significantly higher in the POD3–4 group (74% POD1 vs 89% POD3–4, p=0.03). Both groups were “very satisfied” with home catheter removal (83% POD1 vs 81%, POD3–4, p=0.73). Otherwise, there were no differences in secondary outcomes or complication rates (Table 2). CONCLUSIONS: When considering postoperative urinary retention, home removal of urinary catheters on POD1 was non-inferior to POD3–4 removal. Both groups reported high patient satisfaction and had low complication rates. This option could be safely offered to interested patients.Table 1Table 2