Catheter burden following urogynecologic surgery.

BACKGROUND: Data on the experience that women who undergo urogynecologic surgery have with postoperative catheterization are severely limited. As the importance of our patients' perioperative experience becomes more valued, assessment of the burden of postoperative catheterization, which has not yet been performed, is increasingly needed. OBJECTIVE: The aim of this study was to compare catheter burden in women who self-selected use of an indwelling Foley catheter vs clean intermittent self-catheterization for voiding dysfunction after reconstructive pelvic surgery. STUDY DESIGN: This is a nested study within a nonblinded randomized controlled trial of 2 different voiding trial protocols that was conducted from March to October 2017. Women who underwent pelvic organ prolapse and/or stress urinary incontinence surgery who were English speaking and ≥18 years old with a preoperative postvoid residual <100 mL were included. Participants who did not pass their voiding trial were discharged with an indwelling Foley catheter or self-catheterization per participant preference. Our primary outcome was catheter burden at 1 week after surgery assessed by the Short-Term Catheter Burden Questionnaire, which is a validated 6-item survey comprised of 2 subscales: difficulty of use and embarrassment. Scores range from 3-15 with higher scores indicating greater difficulty and/or embarrassment, and the sum of the 2 subscale scores measures total catheter burden with a higher score indicating greater burden. Secondary outcomes included the rate of urinary tract infection, the number of postoperative clinic visits, and the number of postoperative phone calls. RESULTS: Of 150 participants, 77 women (51%) did not pass their voiding trial; of those, 47 women (61%) were discharged home with an indwelling catheter and 30 women (39%) with self-catheterization. Baseline demographics were similar, except that women who chose an indwelling Foley catheter were older (62±11 vs 55±11 years; P<.01). There were no significant differences between indwelling Foley catheter and self-catheterization in total catheter burden score (18±5 vs 18±6; P=.77), difficulty of use subscale score (8±3 vs 9±3; P=.20), or embarrassment subscale score (10±4 vs 9±4; P=.12). For secondary outcomes, there were no significant differences in rate of urinary tract infection (23% indwelling vs 30% self-catheterization; P=.60). Consistent with study protocol, women who were discharged with an indwelling Foley catheter did have more postoperative clinic visits (2±1 vs 1±1 visits; P<.01), and those women who were discharged with self-catheterization had more postoperative phone calls (2±3 vs 5±3 phone calls; P<.01). Otherwise there was no significant difference in nonvoiding-related clinic visits (1±1 visits for indwelling and self-catheterization; P=.15) or postoperative phone calls (1±2 indwelling vs 2±3 self-catheterization calls; P=.31). CONCLUSION: In women who used either an indwelling Foley catheter or clean intermittent self-catheterization for management of postoperative voiding dysfunction after pelvic reconstructive surgery, there were no differences in difficulty of use, embarrassment, or overall catheter burden. There were also no differences in nonvoiding-related postoperative phone calls or clinic visits, with similar rates of urinary tract infection between the 2 groups.

Health Literacy in Women Presenting to a Urogynecology Practice.

OBJECTIVE: Health literacy (HL) is the degree to which an individual can obtain, process, and communicate basic health information to make appropriate health decisions. Understanding HL of patients can improve outcomes. Thus, we evaluated HL in women with pelvic floor disorders and investigated its relationship to patient demographics, reading level, and cognition. METHODS: We conducted a cross-sectional study with a convenience sample of English-speaking women 18 years or older, recruited from female pelvic medicine and reconstructive surgery clinics from July 2016 to January 1, 2017. Patients with severe visual impairment or severe cognitive impairment were excluded. We used the reading comprehension passages of the short form of Test of Functional Health Literacy in Adults to assess HL, the reading subscale of the Wide Range Achievement Test 3 for reading level, and the Self-administered Gerocognitive Exam for cognition. RESULTS: Among 196 participants, the mean age was 61.1 ± 13.3 years, 84.7% were white, and 54.1% were college educated. Most participants (95.4%) demonstrated adequate HL. Those with adequate HL were younger (60.5 ± 13.2 vs 71.8 ± 10.7, P = 0.01), had less cognitive impairment (12.5% vs 77.8%, P < 0.001), and more frequently had post-high school reading levels (70.1% vs 33.3%, P < 0.001). CONCLUSIONS: Overall HL in the pelvic floor disorder population is high, but older patients with cognitive impairment and lower reading levels are at risk of inadequate HL. Lowering reading levels of educational materials and screening for cognitive impairment may be beneficial to patient understanding and health outcomes.