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This article was written by Abigail Davenport, MD. A prospective observational study at MedStar Health Research Institute has revealed results that change how women recover from pelvic floor surgery.
Research at MedStar Health Research Institute demonstrates that removing a catheter at home is safe for women after pelvic floor surgery, sparing a visit to the hospital and conserving healthcare resources.
Researchers project that about 25% of women in the U.S. will experience pelvic floor disorders such as pelvic organ prolapse, urinary incontinence, or fecal incontinence during their lifetime. After pelvic floor surgery (urogynecologic surgery), about half of women can have difficulty fully emptying their bladder due to swelling and other surgical factors. These women will need to use a catheter, a tube that allows urine to pass out of the body, to urinate for up to a few days.
It is traditional for patients to return to the clinic to have the catheter removed and to ensure that urine can flow out normally. Female patients have reported frustration with needing to return for this simple procedure. Male urology patients have been removing catheters at home for many years, but there was a gap in research about whether women could safely do the same.
So, we took the opportunity to learn and demonstrate a safe, more convenient recovery step for patients. This simple change was so successful that the American Urogynecologic Society and International Urogynecological Association recognized the importance of this work with the Best Clinical Abstract Award at their combined meeting in 2022.
Study results: At-home catheter removal is safe and successful.
We have now completed multiple observational cohort studies comparing the standard procedure of in-office catheter removal and backflow testing to our much less invasive model of catheter removal at home.
Preliminary data from a similar study reported that patients who removed their catheter at home seven days after surgery had a high number of urinary tract infections. The longer a catheter is in place, the higher the risk for infection, so we designed our study to examine catheter removal the day after surgery.
Women received simple instructions to cut the catheter, release any liquid, and remove the tube in the shower. Many patients find that the catheter falls out after it is cut.
In our most recent study, 48 patients removed their catheters at home. Of these, 81% were able to urinate successfully, and 95% of those women did not need another catheter. There were no reports of adverse events, increased visits, or calls to the emergency department.
It was so safe and successful for patients and providers that it became the new standard of care in 2022. We’ve continued to study how our patients have responded and found that they have been pleased with this change; the process is easy, and they are pleased to avoid a return to the office.
Many other institutions nationwide have adopted this practice, and randomized controlled trials have confirmed our results.
Research asks important questions.
Researchers often ask a fundamental question: why do we do this? It’s an essential but critical question because in healthcare, often, the answer is “we don’t know.” We have opportunities to improve healthcare delivery whenever we can identify evidence-based practices that eclipse outmoded standards.
Researching these types of questions allows us to use fewer scarce healthcare resources and improve patient satisfaction. MedStar Health Research Institute is at the forefront of this effort, asking questions and innovating essential, practice-changing knowledge that makes a difference for our communities and beyond.