A previous study determined that patient removal of indwelling urinary catheters at home on postoperative days 3-4 was noninferior to office removal in terms of postoperative retention rates. Home removal was also shown to have high patient satisfaction. While home removal of indwelling urinary catheters for those with immediate postoperative voiding dysfunction was subsequently implemented in our practice, optimal timing of catheter removal was undetermined.
To compare ongoing postoperative urinary retention rates between early home catheter removal (postoperative day 1) and standard home removal (postoperative day 3-4). Secondary outcomes were patient satisfaction, urinary tract infection rates, complication rates, and healthcare utilization.
This was a non-blinded randomized controlled noninferiority trial of cis-women who underwent surgery for stress incontinence and/or pelvic organ prolapse from June 2024 to September 2025 at a single academic institution. Participants who failed a postoperative day 0 voiding trial were randomized 1:1 to early versus standard patient home catheter removal. Instructions were the same for both groups: remove the catheter at 07:00 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 preoperative postvoid residual >150ml), or plan for prolonged postoperative catheterization. Our primary outcome was noninferiority of ongoing postoperative urinary retention, defined as inability to void within 6 hours after home catheter removal and needing continued catheter use, when comparing the early group to the standard group. Noninferiority testing was performed by determining the 95% confidence interval of the difference of proportions using a two-sided z statistic. Secondary outcomes were patient satisfaction, complication rates, and healthcare utilization (patient messages, calls, and office visits), calculated using the Wilcoxon rank sum test for categorical data and Fisher's exact test for nominal data.
A total of 128 participants were randomized. The early and standard groups were similar in demographic characteristics. The rate of ongoing postoperative retention was 14.1% in the early removal group versus 10.9% in the standard removal group (difference 3.2%). The 95% confidence interval of the difference between the two groups met the a priori acceptable limit of 15% (-8.3%, 14.6%), thus meeting criteria for non-inferiority. A subset analysis of participants who underwent concomitant anti-incontinence procedure was inconclusive for noninferiority. Most participants in both groups reported that catheter removal was "not difficult", but this was significantly greater in the standard removal group (72% vs 86%, p=0.045). Both groups were "very satisfied" with home catheter removal (82% vs 81%, p=0.63), postoperative day 1 vs postoperative day 3-4, respectively). Otherwise, there were no differences in secondary outcomes or complication rates.
When considering postoperative urinary retention, patient removal of urinary catheters on postoperative day 1 was non-inferior to postoperative day 3-4 removal. Both groups reported high patient satisfaction and had low complication rates. This option could be safely offered to interested patients.
American journal of obstetrics and gynecology. 2026 Jul 06 [Epub ahead of print]
Lauren Tholemeier, Tejal Vanukuru, Bertie Geng, Christina Kunycky, Elizabeth J Geller, Christine M Chu, Jennifer M Wu, Abishek A Sripad, Marcella G Willis-Gray
Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: ., University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC., Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC., WakeMed Health and Hospitals, Raleigh, NC.