Foley versus intermittent self-catheterization after transvaginal sling surgery: which works best?

To determine whether the duration of catheter use differed between subjects using clean intermittent self-catheterization and those using continuous Foley catheterization after transvaginal sling surgery.

We performed a retrospective analysis of postoperative bladder drainage in 167 consecutive women undergoing transvaginal suburethral sling placement for stress urinary incontinence. The primary outcome measure was the duration of catheter use. Normal voiding was defined as a voided volume equal to twice the residual volume and a residual volume of less than 100 mL for 24 hours. The groups were compared for differences in demographic, preoperative, and postoperative variables using univariate and multivariate analyses. The potential confounding effects of age, concomitant procedures, sling material, preoperative Valsalva voiding, and voiding pressures were investigated using general linear models.

A total of 122 subjects used clean intermittent self-catheterization and 45 had Foley catheter drainage. No differences were found between the groups in terms of concomitant procedures performed and preoperative diagnoses. The median duration of catheter use was 12 days (range 1 to 120) for women using clean intermittent self-catheterization versus 8 days (range 1 to 120) for those using Foley catheter drainage (P = 0.026). This difference was not influenced by age, concomitant procedures, sling material, preoperative Valsalva voiding, or preoperative voiding pressures according to the multivariate analyses.

Although many advocate bladder retraining for postoperative bladder rehabilitation, continuous bladder drainage may result in quicker recovery of normal voiding after sling procedures.