“i’m not going home with a catheter”: patient-centered outcomes associated with peri-operative intermittent catheterization

Abstract

Impaired bladder emptying after surgery is often managed with an indwelling catheter, which can be a source of dissatisfaction, infection, and burden. Intermittent straight catheterization (ISC) is an alternative, though it is less well studied. This study describes patient satisfaction and outcomes associated with planned ISC after outpatient pelvic reconstructive surgery. This was an ancillary analysis of a prospective cohort study at an academic tertiary referral center from September 2018-June 2021. Participants completed pre-operative ISC teaching that included an instructional video (SGS; A Guide to Female Clean Intermittent Catheterization, 6:20 minutes), 1:1 teaching with an RN or MD, and provision of ISC supplies. After surgery, participants were instructed to ISC until they had 2 consecutive outpatient PVRs < ½ voided volume. Demographic information was self-reported, clinical information was abstracted from the medical record, and patient satisfaction was assessed 2 weeks post-procedure. For the 158 participants, mean age was 51.9 ±11.3 years, mean BMI was 28.9 ±5.8 kg/m2, with 140/155 (90.3%) identifying as white and 18/155 (11.6%) as Hispanic. Average provider time-investment in ISC teaching was 9.8 ±5.6 minutes. Providers performing ISC teaching subjectively noted “some” difficulty with ISC for 21/158 (13.3%) participants, “minimal” difficulty for 15/158 (9.5%), and “no” difficulty for 122/158 (77.2%). Mean time from ISC teaching to surgery was 16.3 ±15.6 days. Mean duration of surgery was 43.4 ±28.3 minutes. The average number of outpatient ISCs was 4.9 ±5.7. Median time to achievement of 2 PVRs < ½ voided volume was 6.3 hours (95% CI 5.8–8.6). One-hundred forty-one participants (141/158, 89.2%) performed ≥1 ISC post-operatively, with difficulties noted in Table 1. Most participants reported satisfaction on 2-week follow-up (Figures 1 and 2). Difficulty performing ISC was not associated with time since ISC teaching (p=0.29) or difficulty noted at ISC teaching by the provider (p=0.25). On multiple logistic regression, age, BMI, and prolapse beyond the hymen did not predict difficulty learning or performing ISC. Between ISC teaching and 6 weeks post-procedure, 23/158 (14.6%) participants endorsed symptoms of a urinary tract infection (UTI), 16/158 (10.1%) had a culture-proven UTI, 2/16 (12.5%) of which were diagnosed pre-operatively. Some women undergoing pelvic reconstructive surgery report ease and satisfaction with ISC. This was not limited by age, BMI, prolapse stage, or provider-perceived difficulty learning ISC.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)