What are the orders for a voiding trial?

Voiding Trial Orders

A standard voiding trial should include removal of the Foley catheter, measurement of post-void residual after spontaneous voiding, and specific criteria for passing the trial based on voided volume relative to total bladder volume.

Components of Voiding Trial Orders

Pre-Trial Preparation

• Ensure adequate hydration prior to the trial
• Document baseline urinary symptoms
• Consider initiating alpha-blockers (e.g., alfuzosin 10mg daily) at least 3 days before the trial for patients with urinary hesitancy 1

Catheter Removal Protocol

• Remove Foley catheter on postoperative day 1 for most patients 2
• Two main techniques for catheter removal:
  • Back-fill method: Fill bladder with 300cc saline before catheter removal (superior predictor of adequate bladder emptying) 3
  • Auto-fill method: Remove catheter and allow bladder to fill spontaneously 3

Monitoring Protocol

• Instruct patient to void when feeling the urge
• Measure and record:
  • Time of first void
  • Volume voided (using a measuring container/hat)
  • Post-void residual (PVR) via straight catheterization within 15 minutes of voiding 3
  • Force of urinary stream (patient self-report on scale 0-10) 4

Criteria for Passing Voiding Trial

• Voided volume ≥ two-thirds (66%) of total bladder volume (voided volume + PVR) 3
• OR voided volume > 50% of instilled volume (for back-fill method) 4
• OR force of urinary stream ≥ 5 on a scale of 0-10 4
• PVR < 100-150cc (clinically acceptable threshold)

Failed Voiding Trial Management

• If initial trial fails:
  • Replace Foley catheter or initiate clean intermittent catheterization (CIC)
  • Schedule repeat voiding trial in 2-4 days 4
  • Consider pharmacological therapy with alpha-blockers if not already initiated 1

Post-Trial Monitoring

• Monitor for symptoms of urinary retention or incomplete emptying
• Consider second voiding trial within 3 hours after passing initial trial to confirm sustained voiding ability 5
• Document final PVR before discharge

Special Considerations

Risk Factors for Failed Voiding Trial

• Higher Charlson comorbidity index 6
• Low maximum flow rate on preoperative uroflowmetry (< 15 cc/second) 5
• Non-detrusor contraction voiding pattern 6
• Nocturia 6

Location Options for Catheter Removal

• Both home and office catheter removal show similar patient satisfaction rates (95% satisfaction) 4
• Home catheter removal may be associated with lower rates of urinary tract infection (8.3% vs 26.3%) 4

Follow-Up Recommendations

• Schedule follow-up within 1-2 weeks after successful voiding trial
• Perform post-void residual measurement at follow-up visit 2
• Monitor for symptoms of urinary tract infection, which occur more frequently in patients who fail initial voiding trials (20% vs 6%) 6

Documentation Requirements

• Document voiding trial technique used
• Record voided volumes and post-void residuals
• Note criteria used to determine success or failure
• Document patient education regarding signs/symptoms requiring medical attention

This structured approach to voiding trials provides clear criteria for success while accounting for individual patient factors that may affect voiding function.