REtrospective Multicenter Observational study of immediate Voiding at End of Urinary Sphincter surgery [REMOVE

Abstract

Patients may remain catheterized after Artificial Urinary Sphincter surgery to prevent urinary retention, despite a lack of evidence to support this practice. Our study aims to evaluate the feasibility of outpatient, catheter-free continence surgery using a multi-institutional database. We hypothesize that between catheterized controls and patients without a catheter, there would be no difference in the rate of urinary retention or postoperative complications. We conducted a retrospective review of patients undergoing first-time AUS placement from 2009-2021. Patients were stratified by postoperative catheter status into either no catheter (leaving the procedure without a catheter) or catheter (postoperative indwelling catheter for ∼24 hours). The primary outcome, urinary retention, was defined as catheterization due to subjective voiding difficulty or documented PVR over 250 mL. Our study identified 302 catheter and 123 no catheter patients. Twenty (6.6%) catheter and nine (7.3%) no catheter patients developed urinary retention (p=0.8). On multivariable analysis, controlling for age, cuff size, radiation history and surgeon there was no statistically significant association between omitting a catheter and urinary retention[OR:0.45(95%CI:0.13-1.58);p=0.2]. Furthermore, at 30 months follow up, Kaplan-Meier survival analysis revealed at device survival was 70% (95%CI:62-76%) vs. 69% (95%CI:48-82%) for the catheter and no catheter group, respectively. In our multi-institutional cohort, overall retention rates were low (7%) in groups with a catheter and without. Obviating postoperative catheterization facilitates outpatient incontinence surgery without altering reoperation over medium-term follow-up.