INTRODUCTION: Patient removal of their own Foley catheter at home has gained traction as an alternative to removal by medical personnel in the office for the management of postoperative urinary retention following urogynecologic surgery. This patient-centered approach is hypothesized to be beneficial in terms of convenience, efficiency, and cost for both patients and the healthcare system. OBJECTIVE: We aimed to systematically review the literature regarding at-home Foley catheter removal following urogynecologic surgery compared to in-office catheter removal. METHODS: PubMed, Scopus, Embase, and Web of Science were searched through June 18, 2025. Patients with postoperative urinary retention following prolapse and/or incontinence surgery managed with an indwelling urinary catheter were included. The intervention was home catheter removal; the comparator was office removal. Outcomes were home/office voiding trial failure, healthcare utilization, and patient satisfaction. Adverse events included UTI and recurrent retention. Abstracts and full texts were doubly screened; accepted articles were doubly extracted and doubly assessed for bias using the Covidence platform. Random-effects meta-analyses of pooled proportions and log risk ratios (RR) were used to assess outcomes reported by at least three studies. The I2 statistic was used to reflect heterogeneity. RESULTS: Of 709 abstracts screened, 9 full-text articles were assessed. Three randomized controlled trials (RCTs) and 2 retrospective comparative studies met criteria (Table 1). All 5 studies (n=521) reported rates of voiding trial failure. On meta-analysis, home and office catheter removal were associated with similar rates of voiding trial failure with low heterogeneity (14% 95% CI 10–19%; I2=0% vs 15% 95% CI 9–23%; I2=60%) ; however, RR favored home removal (log RR −0.12 95% CI −0.55–0.32; I2=10%). Meta-analysis was not feasible for healthcare utilization or patient satisfaction outcomes due to heterogeneous reporting. However, home removal was associated with significantly fewer patient encounters in the 3 studies addressing healthcare utilization (n=385). Similar satisfaction scores were reported with home and office removal by the 3 studies addressing patient satisfaction (n=352) (Table 2). Recurrent retention rates were reported by 2 RCTs and one retrospective study (n=346). Meta-analysis of home versus office Foley removal yielded similar rates of recurrent retention (4% 95% CI 0–10%; I2 = not calculable vs 4% 95% CI 0–15%; I2 = not calculable); RR favored home removal (log RR −0.41 95% CI −1.24–0.42, I2=0%). UTI was reported by 2 RCTs and 2 retrospective studies (n=404). UTI rate was not significantly different between home and office catheter removal on meta-analysis, albeit with considerable heterogeneity within the subgroups (14% 95% CI 0–42%, I2=95% vs 23% 95% CI 2–56%; I2=96%); RR favored home removal (log RR −0.37 95% CI −0.86–0.12, I2=16%) (Figures 1 and 2). CONCLUSIONS: Home Foley catheter discontinuation is a safe and effective alternative to office voiding trial, offering comparable patient satisfaction while reducing additional follow-up appointments. This approach may streamline postoperative care without compromising outcomes.Figure: s 1 and 2Table 1Table 2
Carlton et al. (Fri,) studied this question.