INTRODUCTION: Postoperative urinary retention (POUR) is common after urogynecologic surgery with rates ranging from 1.4% to 43%. Optimal management and timing of voiding trials are not standardized, though most urogynecologic surgeons (93–98%) perform trials on postoperative day 1 (POD1). Data on urinary catheter self-discontinuation (CSD) at home on POD1 are limited. Early CSD may reduce risk of urinary tract infection (UTI), mitigate patient anxiety—often cited as the most distressing aspect of postoperative recovery—and improve patient autonomy and satisfaction. Additionally, CSD could reduce healthcare utilization by decreasing the need for office-based catheter removal. OBJECTIVE: This study aimed to evaluate whether home-based CSD on POD1 is non-inferior to standard office-based catheter discontinuation (OD) with regard to rate of POD1 POUR. METHODS: In this noninferiority trial, patients with POUR after urogynecologic surgery (post void residual ≥ 100 mL) who were discharged home POD0 were randomized to CSD or OD on POD1. CSD participants were instructed to remove their catheter at home, whereas OD participants underwent a standard office retrograde-fill voiding trial. The primary outcome was noninferiority of CSD versus OD for POD1 POUR. Secondary outcomes included rates of UTI and recurrent POUR, participant satisfaction with catheter removal method as assessed via the Acceptability of Intervention Measure (AIM) Questionnaire, association of participant satisfaction with health literacy as assessed by the Brief Health Literacy Screen (BHLS), and number of postoperative encounters through 6 weeks. Assuming a 20% POUR rate on POD1 and a 20% noninferiority margin, a sample size of 59 participants per group (N=118) was planned. RESULTS: From August 2023 through May 2025, 121 women (61 CSD and 60 OD) were randomized; baseline perioperative characteristics were similar between groups. POD1 POUR occurred in 14.7% of CSD versus 20% of OD patients (P=0.45), establishing noninferiority (difference +5.3%, 95% CI −15.3, 31.6). No differences were observed in emergency department visits (0 vs 0, P=0.73) or culture-positive UTIs (18.0% CSD vs 18.3% OD, P>0.99). CSD patients reported higher satisfaction than OD (5.0 vs 4.1, P=0.02), with higher BHLS scores positively correlating with greater satisfaction scores (r=0.43, P=0.02); no correlation was seen in the OD group. Participant satisfaction did not differ by randomization group or driving distance to the office. Post-void residual volumes at 6 weeks were similar (16 mL CSD vs 9 mL OD, P=0.94). CONCLUSIONS: Among women with POUR after urogynecologic surgery, POD1 home CSD is non-inferior to standard office-based catheter removal. CSD was associated with higher patient satisfaction, reduced healthcare encounters, and comparable rates of POUR and UTI, regardless of health literacy or primary language. These findings support POD1 CSD as a safe and patient-centered strategy for early catheter removal.Figure 1Table 1Table 2
Mckenzie et al. (Fri,) studied this question.