Patient Perspective on Post-operative Catheterization: A Qualitative Analysis

Objectives: The frequency of urinary retention following urogynecologic procedures approaches 40%. Studies to date have focused on rates of associated urinary tract infections, bladder recovery, and timing of catheter discontinuation; fewer studies have examined patient perspectives. We sought to explore the attitudes and experiences of urogynecologic patients who required postoperative catheterization.

Methods: This subanalysis was performed from semi-structured telephone interviews (6/15/20 – 8/19/20) of women aged ≥60 years who previously underwent prolapse surgery at a large academic medical center between 2018 and 2019. Interviews were audio-recorded and transcribed verbatim; those discussing catheter use were grouped for subanalysis. Content and thematic analyses on attitudes and experience regarding catheter use were performed.

Results: Eleven patients required postoperative catheterization. Two patients who did not discuss catheterization were discharged with indwelling catheters. Nine patients brought up catheterization, including four discharged with indwelling catheter and five performing clean intermittent self-catheterization. Participants averaged 73 (SD: 2) years old; interviews were conducted 1.56 (SD: 0.46) years after their prolapse surgery on average. Two patients underwent obliterative vaginal surgery, four underwent vaginal or laparoscopic uterosacral ligament suspension, and three underwent sacrospinous ligament fixation. Patient attitudes towards catheterization following hospital discharge reflected three themes (Table 1). In the first theme, Perceived Inappropriate Care, patients expressed their belief that catheterization represents an indication for postoperative admission. Patients felt rushed from the hospital and suggested that the decision was financially motivated. The second theme, Mentally Unprepared, reflects surprise at being expected to catheterize, feeling it was an excessive burden, and retention as the biggest postoperative problem. The third theme, Part of the Operative Experience, stood in opposition to the others. Patients aligning with this theme recognized the need for catheterization as common and temporary. Catheterization was felt to be a woman-specific experience. For experiences with home catheterization, three themes emerged (Table 2). In the first, Reliance on Others, patients discussed the need for catheterization assistance from caregivers or nursing staff at home. They expressed gratitude for the instruction and care of nurses. The second theme, Physical Difficulty, included the identification of home catheterization as time-intensive and the most challenging part of recovery. Patients described catheterization as difficult and painful, partially due to challenging anatomy. The third theme, Emotional Burden, included reactions of worry, frustration, and irritation as well as significant relief when catheterization was no longer necessary.

Conclusions: Patient perspectives towards home catheterization reflect negative attitudes and experiences. Given the repeated citation of catheterization as one of the most significant postoperative challenges, additional focus on preoperative education and counseling may be warranted. Nursing support, whether in person or through follow-up calls, helps mitigate the negative experience. Whether and to what degree the type of catheterization impacts patient perspectives merits further study.