Implementation of a standardized voiding management protocol to reduce unnecessary re-catheterization - A quality improvement project

Gynecol Oncol. 2020 May;157(2):487-493. doi: 10.1016/j.ygyno.2020.01.036. Epub 2020 Feb 5.


Objective: To design and implement a standardized postoperative voiding management protocol that accurately identifies patients with urinary retention and reduces unnecessary re-catheterization.

Methods: A postoperative voiding management protocol was designed and implemented in patients undergoing major, inpatient, non-radical abdominal surgery with a gynecologic oncologist. No patients had epidural catheters. The implemented quality improvement (QI) protocol included: 1) Foley removal at six hours postoperatively; 2) universal bladder scan after the first void; and 3) limiting re-catheterization to patients with bladder scan volumes >150 ml. A total of 96 patients post-protocol implementation were compared to 52 patients pre-protocol. Along with baseline demographic data and timing of catheter removal, we recorded the presence or absence of urinary retention and/or unnecessary re-catheterization and postoperative urinary tract infection rates. Fisher's exact test and student's t-tests were performed for comparisons.

Results: The overall rate of postoperative urinary retention was 21.6% (32/148). The new voiding management protocol reduced the rate of unnecessary re-catheterization by 90% (13.5% vs 2.1%, p = 0.01), without overlooking true urinary retention (23.1% vs 20.8%, p = 0.83). Additionally, there was a significant increase in hospital-defined early discharge prior to 11:00 AM (4.0% vs 22.0%, p = 0.022). There was no difference in the postoperative urinary tract infection rate between the groups (p = 1.00). Risk factors associated with urinary retention included older age (p < 0.01), use of medications with anticholinergic properties (p < 0.01), and preexisting urinary dysfunction (p < 0.01).

Conclusions: Implementation of this new voiding management protocol reduced unnecessary re-catheterization, captured and treated true urinary retention, and facilitated early hospital discharge.

Keywords: Bladder voiding; Gynecologic Oncology surgery; Postoperative management; Quality improvement; Urinary retention; Urinary tract infection.

MeSH terms

  • Age Factors
  • Cohort Studies
  • Female
  • Genital Neoplasms, Female / surgery*
  • Gynecologic Surgical Procedures / adverse effects
  • Gynecologic Surgical Procedures / methods
  • Humans
  • Middle Aged
  • Postoperative Complications / diagnostic imaging
  • Postoperative Complications / etiology
  • Postoperative Complications / therapy
  • Quality Improvement
  • Retrospective Studies
  • Urinary Bladder / diagnostic imaging
  • Urinary Catheterization / methods
  • Urinary Retention / diagnostic imaging
  • Urinary Retention / etiology
  • Urinary Retention / therapy*