Home void trials after pelvic reconstructive surgery have demonstrated similar success to clinic void trials and are likely to decrease healthcare burden. Our hypothesis is that by implementing a standardized practice of postoperative home void trials for all urogynecology patients, this will decrease clinic void trials by 50%.

This was a quality improvement process involving patients undergoing urogynecologic procedures at a tertiary care center who were discharged home with an indwelling catheter.  A standardized and universal home void trial protocol was implemented in December 2023. This involved providing patients with a handout pre-operatively detailing home void trial instructions and steps to schedule an urgent clinic assessment if they fail their home void trial. Surgeons and nursing staff were educated on this protocol at each hospital site. For patients needing clinic assessment, nursing staff were given a standardized protocol for clean intermittent catheterization (CIC) teaching. We retrospectively reviewed data 6 months prior to and after implementation of this protocol, with a two month wash out. The primary outcome abstracted from the electronic medical record was the number of clinic void trial visits prior to and after implementation. Additional outcome measures included the number of post-operative telephone calls, rate of urinary retention, as well as rates of post-operative complications.

A total of 144 patients were evaluated: 72 in each pre-implementation and post-implementation group. Baseline characteristics were similar between the two groups. Procedures included minimally invasive sacrocolpopexy, sacrospinous ligament fixation, uterosacral ligament suspension, hysterectomy, mid-vaginal repairs, colpoclesis, retropubic and single incision slings, fascial slings, and Burch colposuspension. Pre-implementation, 62.5% of patients had home void trials, compared to 95.8% post-implementation (p<0.01), Table 1. There was no difference in the rate of post-operative urinary retention between groups: 6 in pre-implementation and 7 in the post-implementation group. Of these, 8 were taught CIC and 3 had an indwelling catheter placed per patient preference. Two patients in the post-implementation group experienced difficulty with contacting the clinic, resulting in an emergency department visit for retention.  There was no difference in phone calls initiated by staff or patients between the groups, Table 2. There was no difference in rates of UTI or any postoperative complications. Sling lysis was performed in one patient in the pre-implementation group and two patients in the post-implementation group due to persistent retention.

Implementation of a standardized and universal home void trial protocol decreased clinic void trials by 54%. There was no increase in rate of post-operative urinary retention, UTIs, or catheter-related phone calls with protocol implementation.

The implementation of a standardized process for home void trials following urogynecologic surgery is a feasible way to decrease the number of clinic visits without increasing rates of post-operative complications or the number of staff- or patient-initiated phone calls.