• The planned date for catheter removal should be clearly documented in the postoperative care plan
• All urethral catheters should be removed at 06.00 the next morning as per ERAS unless otherwise stated in the operation notes or there are clinical concerns
• Patients who have had colposuspension (open/laparoscopic) or AFS usually have indwelling catheter for at least 48 hours
• Women who do not have an indwelling catheter (this includes midurethral sling and bladder neck injection) should have a trial of void 4 hours after surgery
• For the trial of void, women should be encouraged to drink normally and aim to pass urine at around 4 hrs.
• All urogynaecological procedures, ie those for incontinence and prolapse repair, should have a bladder scan after the first two voids. The residuals should be recorded in the ‘bladder diary’ (see Appendix 1).

• Measure the urine volume after each void, no later than 6 hours from catheter removal
• Residual volume should be measured immediately after the patient passes urine
• If uncomfortable and unable to pass urine 4 hours after catheter removal, check bladder residual by scan and follow protocol as below (Table 1).

• These women are very likely to have initial short term voiding dysfunction (approximately 67% based on local data) and are taught Clean Intermittent Self Catheterisation (CISC) pre-operatively. They should be encouraged and supported to do CISC if required post-operatively. Patients who are unable to perform CISC should be discharged with an indwelling catheter. They must also be referred to Urogynaecology nurses at the Victoria ACH for ongoing care.  This is done via the following referral form: Clean Intermittent Catheterisation referral form.

Table 1: Assessment and Management of Post-void Residual 

• If the patient is discharged with an indwelling catheter following a midurethral sling procedure, inform the surgeon who performed the operation as early division of the tape may be required
• Patients with voiding concerns following bladder neck injection should have CISC performed by nursing staff. If voiding fails to improve over 48 hours, offer to teach patient CISC and refer to urogynaecology nurses. Discuss with the urogynaecology team if patient is unable to perform CISC and continues to have voiding difficulties. Do not insert an indwelling catheter as this may compromise the outcome of the procedure.
• Women who have a successful TWOC but remain as an inpatient should continue to have their bladder/voiding assessed by monitoring input/output. Ensure patient is voiding 3-4 times/day and has no sensation of incomplete bladder emptying

• Ensure woman understands catheter care and a follow-up appointment for TWOC in the gynaecology ward is in place. She should have an emergency contact number for the ward.
• Prophylactic antibiotics are not routinely required unless symptomatic of infection.
• A Foley catheter size 12 with a flip-flo valve and leg bag should be used. The valve should be released every 4 hours during the day and the leg bag should be left on free drainage overnight.

Table 2: First TWOC after an episode of retention

• If TWOC unsuccessful after 1 week, please inform the responsible clinician

Postoperative Bladder Diary (Word doc)

QEUH
Karen Nicolson        
Senior Charge Nurse, Urogynaecology
Karen.Nicolson@ggc.scot.nhs.uk
01412012264

PRM
Julie Graham        
Senior Charge Nurse, Gynaecology
Ward 56 
Julie.Graham@ggc.scot.nhs.uk
01412114433

RAH
Ward 32
01418879111