Authors (including presenting author) :
Tse YB(1), Wong PY(1), Ng SL(1), Chun CC(2), Ng TL(1)(2)
Affiliation :
(1)Division of Urology, Department of Surgery, Queen Mary Hospital
(2)Department of Surgery, The University of Hong Kong
Introduction :
The placement of urinary catheters is a common procedure, often used for acute urinary retention or during surgical interventions. This condition impacts 5% to 70% of patients. The removal of the urinary catheter assesses a patient’s ability to void independently after catheter removal. Post-removal, patients are encouraged to attempt urination within a specified timeframe, typically aiming to void at least twice, with bladder ultrasounds performed to ensure complete emptying.
The catheter removal process can be lengthy, the average stay at these out- patient centres is time limited. Elderly patients, may struggle to complete this process within the allotted time, potentially necessitating re-catheterization. To address this, we have adopted an internationally recognized method involving saline solution administration before catheter removal, with volumes varying from 200ml to amounts that elicit urinary urgency.
Objectives :
To create a safe and more efficient catheter removal process for elderly, improving patient outcomes by accelerating their time to void and discharge.
Methodology :
Female aged above 70’s without active urinary tract infection referred to Urology nurse for trial without catheter (TWOC) in 2024 recruited. Methods and successful criteria for TWOC as usual practice with addition of infusing 150ml of saline to induce urgency before removal of catheter. We compared the patient journeys between spontaneous voiding method in 2023 and retrograde voiding method in 2024 in terms of time to void and successful TWOC outcomes.
72 female patients under spontaneous voiding method were compared to 34 female patients used retrograde voiding method. These patients were comparable in terms of age and medical history.
Result & Outcome :
The mean time from catheter removal to first void decreased from 141 minutes to 109 minutes (p < 0.021). The total time for successful TWOC reduced from 244 minutes to 193 minutes (p < 0.015). The percentage of patients achieving the first void within 1.5 hours increased from 14.5% to 50% (p < 0.001) , and those achieving the second void within 4 hours rose from 50% to 76.9% (p < 0.028). There was no patient requiring 2 days method or reported NPU at initial TWOC, compared to the spontaneous voiding method group.
The adoption of retrograde voiding method prior to catheter removal has significantly enhanced the efficiency of the TWOC process for elderly patients. Our findings demonstrate improved voiding and discharge time, facilitating a more streamlined service at the day centre.
