Patient-led Trial Without Catheter (TWOC) - Is it feasible?
BAUS ePoster online library. Hatem E. Jun 25, 2019; 259491; P12-7
Dr. Emer Hatem
Dr. Emer Hatem
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Abstract
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INTRODUCTION:
Post-operative urinary catheters pose a barrier to discharge, and outpatient trial without catheter (TWOC) clinics are ever-saturated. Our centre aims to perform Greenlight laser prostatectomy as a day-case, following which we endorse TWOC between post-operative day 1-3. Factors delaying TWOC include larger, vascular prostates, longer vaporisation time or pre-operative urinary retention. This study tests the feasibility of patient-led TWOC.

Methods:

We prospectively collected patients having laser prostatectomy, or other procedure requiring post-operative catheterisation from February to September 2018. Excluded were those with cognitive or social barriers, or operative factors which deemed hospital TWOC safer. Patients were taught to remove their catheter, instructed to do so early on a designated day and to attend outpatients had they had difficulty voiding by noon. An information sheet with instructions/contact details was given. Follow-up was via telephone.

RESULTS:

62 suitable patients were included. Of these, 8 changed their mind and returned for nurse-led TWOC, 2 were constipated so did not perform the TWOC and one catheter fell out. 49 patients (79.0%) removed their catheter as directed and 45 of these (91.8%) successfully voided. Four (8.2%) failed and returned for catheterisation. All subsequently passed a nurse-led TWOC. From the successful cohort, four patients attended the Emergency Department; with haematuria, urinary tract infection, incontinence, and anxiety respectively. All were discharged. Follow-up revealed the majority of the successful (82.2%) were happy, given clear instructions to follow. .

CONCLUSIONS:

Patient-led TWOC is feasible and acceptable to patients, provided a clear contingency plan should they fail to void.
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