Variables associated with an inability to learn clean intermittent self-catheterization after urogynecologic surgery


Introduction and hypothesis

Post-operative urinary retention is a common problem affecting close to half of all women undergoing pelvic reconstructive surgery. This was an exploratory analysis that was aimed at identifying factors associated with an inability to learn clean intermittent self-catheterization (CISC) after a failed post-operative retrograde voiding trial (RGVT).


We performed a retrospective case–control study of women who underwent pelvic organ prolapse or urinary incontinence surgery within a single division from 2016 to 2018. We compared women who could learn CISC with those unable to learn and discharged home with an indwelling catheter (IC). Analyses were carried out using Fisher’s exact test, the Mann–Whitney U test, the Chi-squared test, and the t test with logistic regression.


Of the 202 women who failed their RGVT, 134 (66.3%) were able to learn CISC and 68 (33.7%) were not. Older age, urinary incontinence, diabetes and colpectomy/colpocleisis were associated with an inability to learn CISC (p < 0.05). Women with an IC were more likely to have an office visit related to catheter care (65.7% vs 5.2%, p < 0.001). A UTI within 30 days of surgery was more common with CISC (16.4% vs 6.0%, p = 0.037). In a multivariate logistic regression model, each increasing year of age was associated with a 1.036-fold decrease in the ability to learn CISC (aOR 1.036, 95% CI 1.002–1.071; p = 0.04).


Increasing age was the only variable identified on multivariate logistic regression as a risk factor for failure to learn CISC. Further studies are needed to identify barriers to learning post-operative self-catheterization.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Geller EJ. Prevention and management of postoperative urinary retention after urogynecologic surgery. Int J Women’s Health. 2014;6:829–38.

    Article  Google Scholar 

  2. 2.

    Walters MD, Karram MM, editors. Urogynecology and reconstructive pelvic surgery. 4th ed. Philadelphia: Elsevier; 2015.

    Google Scholar 

  3. 3.

    Hakvoort RA, Dijkgraaf MG, Burger MP, Emanuel MH, Roovers JP. Predicting short-term urinary retention after vaginal prolapse surgery. Neurourol Urodyn. 2009;28(3):225–8.

    Article  Google Scholar 

  4. 4.

    Turner LC, Kantartzis K, Shepherd JP. Predictors of postoperative acute urinary retention in women undergoing minimally invasive sacral colpopexy. Female Pelvic Med Reconstr Surg. 2015;21(1):39–42.

    Article  Google Scholar 

  5. 5.

    Book NM, Novi B, Novi JM, Pulvino JQ. Postoperative voiding dysfunction following posterior colporrhaphy. Female Pelvic Med Reconstr Surg. 2012;18(1):32–4.

    Article  Google Scholar 

  6. 6.

    Madersbacher H, Cardozo L, Chapple C, et al. What are the causes and consequences of bladder overdistension? ICI-RS 2011. Neurourol Urodyn. 2012;31(3):317–21.

    Article  Google Scholar 

  7. 7.

    Hakvoort RA, Thijs SD, Bouwmeester FW, et al. Comparing clean intermittent catheterisation and transurethral indwelling catheterisation for incomplete voiding after vaginal prolapse surgery: a multicentre randomised trial. BJOG. 2011;118(9):1055–60.

    CAS  Article  Google Scholar 

  8. 8.

    Kisby CK, Polin MR, Visco AG, Siddiqui NY. Same-day discharge after robotic-assisted sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2018; DOI: 10.1097/SPV.0000000000000573.

  9. 9.

    Carter-Brooks CM, Du AL, Ruppert KM, Romanova AL, Zyczynski HM. Implementation of a urogynecology-specific enhanced recovery after surgery (ERAS) pathway. Am J Obstet Gynecol. 2018;219(5):495.e1–495.e10.

    Article  Google Scholar 

  10. 10.

    Bickhaus JA, Drobnis EZ, Critchlow WA, Occhino JA, Foster RT Sr. The feasibility of clean intermittent self-catheterization teaching in an outpatient setting. Female Pelvic Med Reconstr Surg. 2015;21(4):220–4.

    Article  Google Scholar 

  11. 11.

    Webb RJ, Lawson AL, Neal DE. Clean intermittent self-catheterisation in 172 adults. Br J Urol. 1990;65(1):20–3.

    CAS  Article  Google Scholar 

  12. 12.

    Cobussen-Boekhorst H, Beekman J, van Wijlick E, Schaafstra J, van Kuppevelt D, Heesakkers J. Which factors make clean intermittent (self) catheterisation successful? J Clin Nurs. 2016;25(9-10):1308–18.

    Article  Google Scholar 

  13. 13.

    Dieter AA, Amundsen CL, Edenfield AL, et al. Oral antibiotics to prevent postoperative urinary tract infection: a randomized controlled trial. Obstet Gynecol. 2014;123(1):96–103.

    CAS  Article  Google Scholar 

  14. 14.

    Nygaard I, Brubaker L, Chai TC, et al. Risk factors for urinary tract infection following incontinence surgery. Int Urogynecol J. 2011;22(10):1255–65.

    Article  Google Scholar 

  15. 15.

    Prieto J, Murphy CL, Moore KN, Fader M. Intermittent catheterisation for long-term bladder management. Cochrane Database Syst Rev. 2014;8:CD006008.

    Google Scholar 

  16. 16.

    Sutkin G, Alperin M, Meyn L, Wiesenfeld HC, Ellison R, Zyczynski HM. Symptomatic urinary tract infections after surgery for prolapse and/or incontinence. Int Urogynecol J. 2010;21(8):955–61.

    Article  Google Scholar 

  17. 17.

    Lavelle ES, et al. Nitrofurantoin prophylaxis in women undergoing catheterization for acute postoperative urinary retention after pelvic reconstructive surgery: a randomized, double-blind, placebo-controlled trial. American Urogynecologic Society Pelvic Floor Disorders Week. Chicago; October 9–13, 2018.

  18. 18.

    Elkadry EA, Kenton KS, FitzGerald MP, Shott S, Brubaker L. Patient-selected goals: a new perspective on surgical outcome. Am J Obstet Gynecol. 2003;189(6):1551–7, discussion 1557-8.

    Article  Google Scholar 

  19. 19.

    Brubaker L, Litman HJ, Rickey L, et al. Surgical preparation: are patients "ready" for stress urinary incontinence surgery? Int Urogynecol J. 2014;25(1):41–6.

    CAS  Article  Google Scholar 

  20. 20.

    Chong C, Kim HS, Suh DH, Jee BC. Risk factors for urinary retention after vaginal hysterectomy for pelvic organ prolapse. Obstet Gynecol Sci. 2016;59(2):137–43.

    Article  Google Scholar 

Download references


Our research was supported by the National Institutes of Health through Grant Number UL1TR001857.

Author information



Corresponding author

Correspondence to Jessica C. Sassani.

Ethics declarations

Conflicts of interest

The authors report that they have no conflicts of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sassani, J.C., Stork, A., Ruppert, K. et al. Variables associated with an inability to learn clean intermittent self-catheterization after urogynecologic surgery. Int Urogynecol J 31, 1401–1407 (2020).

Download citation


  • Pelvic organ prolapse
  • Post-operative urinary retention
  • Self-catheterization