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This randomized controlled trial shows that early home removal of indwelling urinary catheters on postoperative day 1 after urogynecologic surgery is noninferior to the standard removal on postoperative days 3-4 in terms of postoperative urinary retention rates. Both groups exhibit similarly high patient satisfaction and low complications, suggesting that early removal is a safe, patient-friendly option.
Study Background
Postoperative urinary catheterization is routinely employed after urogynecologic surgeries such as stress urinary incontinence and pelvic organ prolapse repair to ensure adequate bladder drainage and monitor voiding function. However, prolonged catheterization increases risks such as urinary tract infections (UTIs), discomfort, and decreased patient satisfaction. Traditionally, catheters have been removed in the office on postoperative days 3 to 4 after a voiding trial confirms bladder function. Earlier removal could potentially reduce infection risks and improve patient comfort, but concerns remain about increased risk of postoperative urinary retention requiring recatheterization.
Prior work had demonstrated that patient self-removal of urinary catheters at home on days 3 to 4 was noninferior to office removal, with high satisfaction. Yet, the ideal timing of removal to balance early mobilization, safety, and patient experience had not been established.
Study Design
This single-center, non-blinded, randomized controlled noninferiority trial was conducted between June 2024 and September 2025. Cisgender women undergoing surgery for stress urinary incontinence and/or pelvic organ prolapse who failed an initial postoperative day 0 voiding trial were enrolled and randomized in a 1:1 ratio to either early home catheter removal on postoperative day 1 or standard removal on postoperative days 3 to 4. Patients with preexisting voiding dysfunction or planned prolonged catheterization were excluded.
Participants received standardized instructions to remove the catheter at 7:00 AM on their assigned postoperative day, drink two glasses of water, and contact their clinic if unable to void within five hours to arrange an office voiding trial. The primary endpoint was ongoing postoperative urinary retention, defined as inability to void within six hours post-catheter removal necessitating continued catheterization.
Secondary outcomes included patient satisfaction with the catheter removal process, urinary tract infection rates, complications, and healthcare utilization quantified by patient messages, phone calls, and office visits. Statistical analysis for noninferiority was based on the two-sided 95% confidence interval of differences in retention rates, with a predefined noninferiority margin of 15%. Other outcomes were analyzed using Wilcoxon rank sum test and Fisher’s exact test.
Key Findings
A total of 128 participants were randomized evenly between early (postoperative day 1) and standard (day 3-4) catheter removal groups. Baseline demographics were similar between groups.
The primary outcome showed that the rate of postoperative urinary retention was 14.1% in the early removal group versus 10.9% in the standard group. The difference in retention rates was 3.2%, with a 95% confidence interval of -8.3% to 14.6%, which fell within the a priori noninferiority margin of 15%. This finding confirms that early catheter removal at home is noninferior to the standard later removal regarding urinary retention risk.
Subgroup analysis in patients undergoing concomitant anti-incontinence procedures was inconclusive for noninferiority, indicating potential complexity in these cases warranting further study.
Regarding patient experience, most patients reported catheter removal was “not difficult,” though this was more frequent in the standard removal group (86%) than the early group (72%) (p=0.045). However, overall satisfaction was high and comparable between groups, with 82% and 81% reporting being “very satisfied” in early and standard groups, respectively.
No statistically significant differences were observed in complication rates, urinary tract infections, or healthcare utilization metrics, underscoring the safety and feasibility of early catheter removal.
Expert Commentary
This study provides clinically relevant evidence supporting earlier home removal of catheters following urogynecologic surgeries, a practice that may reduce exposure to catheter-associated risks without increasing urinary retention. The rigorous noninferiority design strengthens the validity of the findings. The standardized patient instructions and clear follow-up protocols commendably ensured patient safety.
Study strengths include randomized assignment, adequate sample size, and comprehensive assessment of clinically meaningful outcomes including retention, satisfaction, and healthcare use. Limitations include the single-center setting potentially limiting generalizability, non-blinded design, and inconclusive subgroup results for patients undergoing additional complex procedures.
From a mechanistic perspective, early catheter removal may promote more rapid recovery of bladder function and reduce infection risk by limiting foreign body exposure time. Nonetheless, cautious application in patients with complex surgeries or preoperative voiding impairments remains necessary.
Conclusion
Early home catheter removal on postoperative day 1 after urogynecologic surgery is noninferior to removal on days 3 to 4 with respect to postoperative urinary retention. Both timing strategies provide high patient satisfaction and low complication rates. This evidence supports offering patients the option of early catheter removal with clear instructions and access to follow-up care. Further research should explore applicability in patients undergoing complex concomitant procedures.
Funding and Clinical Trials Registration
Details regarding funding sources and clinical trial registration were not provided in the original publication synopsis.
References
Tholemeier L, Vanukuru T, Geng B, et al. Early patient removal of urinary catheters after urogynecologic surgery, a randomized trial. American Journal of Obstetrics and Gynecology. 2026 Jul 6. PMID: 42409155. Available at: https://pubmed.ncbi.nlm.nih.gov/42409155/
