Authors (including presenting author) :
Leung CYJ (1), Chu TY (1)
Affiliation :
(1) Urology, Department of Surgery, PMH
Introduction :
Urinary catheterization is a common procedure to manage patient with acute retention of urine (AROU) in surgical department. Traditionally, these patients required in-patient urologist assessment and treatment before discharge or referring to urology out-patient clinic for catheter management and further follow up. After assessment by urologist, some patients will be referred to Trial Without Catheter (TWOC) clinic in Day ward for trial wean off Foley catheter. In April 2018, ‘Protocol for Management of Male AROU’ and ‘Protocol for Management of Female AROU’ in Surgical Department of PMH commenced, aiming to improve the quality of care to patients with non-complicated AROU.
Objectives :
1. To reduce unnecessary hospitalization and shorten length of stay by minimizing urology in-patient consultation 2. To standardize and tailor-made treatment plan to patient with non-complicated retention of urine in department 3. To reduce chance of CAUTI related to prolonged catheterization because of long waiting time for outpatient follow up.
Methodology :
Protocol for management of male and female with AROU have been implemented since 2018 April. Up to 2020 December, total 16 patients under the protocol were referred to TWOC clinic in Day ward. At TWOC clinic, Foley's catheter was removed and patient was checked for voiding and post void residual urine (PVRU). If PVRU>300ml, Foley’s catheter will be re-inserted. All patients in TWOC session will be assessed by Urologist at PM session on the same day, treatment and further plan will be discussed with patient and relatives.
Result & Outcome :
Finally, 12 cases (75%) were success TWOC and 4 cases (25%) failed. Long term Foley treatment was chosen by one patient, one case was referred to CNS for repeat TWOC and the other two patients decided for TURP. No CAUTI was noted at TWOC session. Patients with indwelling catheter (under TWOC protocol) were referred to TWOC clinic in 2 weeks directly, thus can shorten the waiting time to see urologist for assessment and treatment either in-patient consultation or referred to out-patient clinic which patients usually would have the appointment longer than 2 weeks previously. Also, patients can receive suitable treatment and education promptly in TWOC session. Using the ‘Protocol for Management of Male or Female AROU patient’ can minimize unnecessary and prolonged urinary catheterization and shortened hospital length of stay.
