From Pilot to Practice: Clinical Implementation of At-Home Catheter Self-Discontinuation Protocol Reduces Healthcare Utilization Without Compromising Safety

INTRODUCTION: Urinary retention occurs in up to 43% of patients after pelvic reconstructive surgery. Conventional management requires patients to return to clinic for catheter removal, an early postoperative visit that can be uncomfortable and disruptive. The Feasibility of Transurethral Catheter Self-Discontinuation (FLOTUS) pilot study demonstrated that at-home catheter removal on postoperative day one is a safe, patient-centered alternative. However, the real-world impact of this protocol on outcomes and healthcare utilization at scale has not been evaluated. OBJECTIVE: The primary objective of this study was to evaluate patient outcomes and healthcare utilization following clinical implementation of the FLOTUS protocol at a high-volume urogynecology practice. We predicted that safety outcomes would be similar between the two groups, while healthcare utilization would be decreased for the group of patients who used the FLOTUS protocol once it was clinically implemented as standard of care. METHODS: We performed a retrospective cohort study of adult women who underwent outpatient benign pelvic reconstructive surgery between February 2022 and February 2025 at a tertiary urogynecology division. Patients managed under the clinically implemented FLOTUS protocol were compared with those from the original pilot study conducted in a research setting. Demographic, clinical, and operative characteristics were abstracted from the electronic medical record. Primary outcomes included void trial (VT) success, catheter reinsertion or need for clean intermittent catheterization (CIC), and 30-day surgical complications. Secondary outcomes included healthcare utilization within 30 days, specifically patient-initiated calls or messages, office visits, and emergency room encounters. Descriptive analyses were performed; adjusted analyses are ongoing. RESULTS: 1,119 patients were eligible for voiding trial via the FLOTUS protocol. Of these, 380 patients (34%) failed their immediate postoperative day 0 void trial and were discharged on the self-discontinuation protocol. 52 patients (13.7%) failed their void trial on postoperative day 1 and required further catheterization. Demographics, rates of VT success, catheter reinsertion, and CIC did not differ significantly between the clinically implemented cohort and the original pilot study. In terms of healthcare utilization, patients managed under the clinically implemented protocol made significantly fewer calls and messages to the office within 30 days compared with the pilot cohort (median 2 vs 3, p<0.001), representing a one-third reduction. There were no statistically significant differences between groups in the rates of surgical complications, office visits, or emergency room encounters within 30 days. CONCLUSIONS: Clinical implementation of the FLOTUS protocol in a high-volume urogynecology practice confirms that at-home catheter self-discontinuation is both safe and effective outside of a research setting. Compared with the original pilot study, the clinically implemented protocol achieved comparable void trial outcomes while significantly reducing postoperative patient calls and messages, reflecting decreased burden on both patients and clinical staff. Importantly, complication rates, office visits, and emergency room encounters were not increased. Beyond improving efficiency, this approach empowers patients to actively participate in their recovery and eliminates the need for an early, often uncomfortable, postoperative clinic visit.Table 1