Retrospective Multicenter Observational Study of Immediate Voiding at End of Urinary Sphincter Surgery (REMOVE)

Thomas Kozar, John Michael Kaylor, Cynthia Hinderscheid, Jamee Schoephoerster, Albert E. Holler, Edward J. Wright, Joseph J. Pariser, William Boysen, Lucas Wiegand, J. Patrick Selph, Andrew J. Cohen

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Purpose:Patients may remain catheterized after artificial urinary sphincter surgery to prevent urinary retention, despite a lack of evidence to support this practice. Our study aims to evaluate the feasibility of outpatient, catheter-free continence surgery using a multi-institutional database. We hypothesize that between catheterized controls and patients without a catheter, there would be no difference in the rate of urinary retention or postoperative complications.Materials and Methods:We conducted a retrospective review of patients undergoing first-time artificial urinary sphincter placement from 2009-2021. Patients were stratified by postoperative catheter status into either no-catheter (leaving the procedure without a catheter) or catheter (postoperative indwelling catheter for ∼24 hours). The primary outcome, urinary retention, was defined as catheterization due to subjective voiding difficulty or documented postvoid residual over 250 mL.Results:Our study identified 302 catheter and 123 no-catheter patients. Twenty (6.6%) catheter and 9 (7.3%) no-catheter patients developed urinary retention (P =.8). On multivariable analysis, controlling for age, cuff size, radiation history and surgeon, there was no statistically significant association between omitting a catheter and urinary retention (OR: 0.45, 95% CI: 0.13-1.58; P =.2). Furthermore, at 30 months follow-up, Kaplan-Meier survival analysis revealed that device survival was 70% (95% CI: 62%-76%) vs 69% (95% CI: 48%-82%) for the catheter and no-catheter group, respectively.Conclusions:In our multi-institutional cohort, overall retention rates were low (7%) in groups with a catheter and without. Obviating postoperative catheterization facilitates outpatient incontinence surgery without altering reoperation over medium-term follow-up.

Original languageEnglish (US)
Pages (from-to)865-873
Number of pages9
JournalJournal of Urology
Issue number6
StatePublished - Dec 1 2023

Bibliographical note

Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.


  • ambulatory surgical procedures
  • artificial
  • equipment failure
  • stress
  • urinary incontinence
  • urinary retention
  • urinary sphincter

PubMed: MeSH publication types

  • Observational Study
  • Multicenter Study
  • Journal Article


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