Urology - Trial Without Catheter (TWOC)

What is a trial without catheter?

A trial without catheter (TWOC) is the removal of a urinary catheter (the tube inserted into your bladder to drain urine). This is done to see if you can pass urine and empty your bladder without it. If you have a supra-pubic catheter (a tube inserted into your bladder through your abdomen) then this will be clamped rather than removed in the first instance.

This procedure is usually carried out in the community by the community continence team, either in your home setting or a clinic environment. Occasionally patients come back to hospital as a day attender for removal of their catheter. You should anticipate being in the hospital for up to 4 to 5 hours.

What are the alternatives?

The catheter may have been inserted for a number of reasons, the most common of these being that you were found not to be emptying your bladder fully when you passed urine. There are no alternatives to removing your catheter to see if you can pass urine and empty your bladder, although you may need to go for further investigations to see why this is happening to you.

What are the benefits?

The benefits of this procedure are to hopefully enable you to pass urine and empty your bladder on your own, without needing a catheter.

What should I expect on the day of the procedure? 

This may differ depending on where your TWOC will be taking place but as a general rule the following applies.

• The procedure will be fully explained to you again by your practitioner
• Before we remove your catheter, normal saline may be put into your bladder for you to urinate out afterwards. This is done to check that you can empty your bladder after the procedure
• You will be asked to drink fluids once the catheter is removed. Ideally you should drink a glass or two every hour to slowly fill your bladder
• You will be in a seated position whilst having this procedure
• You will remain in your own clothes for this procedure. However, it may be advisable to bring a spare pair of trousers and under garments with you just in case
• Once you feel able to pass urine, you will pass this via a bottle/ measuring jug
• Throughout your trial without catheter the Practitioner will perform a bladder scan(s) to see if you are managing to empty your bladder properly
• If your bladder is not emptying properly, or if you have any difficulty passing urine, then you will be re-catheterised or with your consent you may be offered to learn intermittent self- catheterisation and appropriate follow-up will be arranged
• If you do not require re-catheterisation, you will be sent home with some written advice and appropriate follow-up will be arranged

After the procedure

If you have not been re-catheterised:

• You are advised to drink 1.5 – 2 litres of fluid a day
• Ensure you pass urine at least every 4 hours even if you do not have the urge to go, this is to improve the muscle of your bladder after you have had a catheter in for a while
• You may be given a course of antibiotics. Please ensure that you complete the course
• Appropriate follow-up will be arranged with your consultant if required
• You are still at risk of needing to have a catheter for 1-2 weeks following the procedure

If you get any of the following symptoms, then this may be a sign that you do:

• Unable to pass urine
• Abdominal pain
• A feeling of incomplete emptying
• Increased frequency of passing urine
• Dribbling urine

If you think you are going back into retention and need a catheter putting back in, then you should attend the Accident and Emergency department of your local hospital.

If you have been catheterised

• Appropriate follow-up will be arranged with your consultant, this may include investigations prior to you seeing your consultant
• All patients with a urinary catheter are at risk of a bladder infection. You are advised to drink plenty of fluids, ideally 2-3 litres a day whilst you have the catheter in place
• You may be given a course of antibiotics to take at home. Please complete the course
• It is still possible to develop an infection

If you develop any of the following symptoms, then you may have an infection:

• High temperature, feeling hot
• Shivering and shaking
• Feeling unwell or flu like symptoms
• Cloudy urine or blood in the urine

You should contact your GP if you suspect an infection is developing. You will need to provide a sample of urine for your GP to send for analysis.

If you require any further information, please contact the urology nurse specialist team on 0161 627 8792.