The CLAHRC West project to develop a protocol to reduce post-operative urinary retention (PO-UR) came from an idea by patient contributor Nick Leggett.
Not being able to pass urine is common after surgery, affecting between 5 and 70 per cent of patients, depending on the kind of surgery and their personal risk profile. Catheterisation – inserting a tube to drain the bladder – lengthens inpatient stay and poses significant added risks, such as urinary infection and damage to the bladder neck. Patients can find catheterisation invasive, undignified, distressing and uncomfortable. Post-operative urinary retention creates substantial financial burdens for the NHS, by slowing patient flow and creating additional treatment needs.
Nick submitted an idea for research through the CLAHRC West open call in 2016. As a patient, Nick experienced post-operative urinary retention, requiring catheterisation, after three different common non-urgent surgical procedures.
Before three subsequent and comparable conditions requiring surgery, Nick investigated clinical research literature on PO-UR. Through negotiation with clinicians treating him, based on this investigation, he avoided PO-UR following these procedures. This led him to hypothesise that it should be possible to specify criteria to identify those at risk of post-operative urinary retention, and to develop methods to reduce its likelihood, following certain common non-urgent surgical procedures.
The project was taken on by NIHR CLAHRC West and Nick proposed that it should be developed, at every stage, as a pioneering form of co-production.
So, at the same time as seeking to benefit patients and the wider NHS by reducing a common,expensive and unpleasant adverse effect of surgery, the project aims to identify radical new ways in which patients and the public can collaborate in clinical research.
The research team structure models co-production. Dr Penny Whiting, Epidemiology Team Lead at NIHR CLAHRC West, and Nick are joint principal investigators on the project. Nick has an honorary research associate contract at the University of Bristol to enable him to perform this role.
There was initial difficulty in identifying clinicians eager to join the project. Post-operative urinary retention is not seen as a major problem by the medical community, but more as a common side effect of surgery that can be ‘solved’ by catheterisation.
This led us to contact Tony Blacker, the consultant endourologist from University Hospital Coventry and Warwick (UHCW) who was the lead clinician co-producing, with Nick, a successful set of methods to avoid post-operative urinary retention. Tony was keen to join the project team.
The first stage of the project has been two systematic literature reviews, to identify risk factors and treatments for post-operative urinary retention. Nick has contributed to all stages of the review. He has screened titles and abstracts, and he has assessed full text papers for inclusion.
We have supported Nick through training for each task that he has taken on. Nick’s inputs from personal experience have assisted the team in several key inclusion decisions, as the review proceeded. Particularly, we decided to focus the review on three common procedures, with high post-operative urinary retention incidence:
- hernia surgery
- hip and knee replacement
Nick has added value to the project, not just from patient experience, but also from his understanding of research and practice in public involvement. Nick has been a member of the strategy group of People and Health West of England, and is involved in other research organisations and projects, as well as being a regular member of the University of the West of England PPI Journal Club.
The literature reviews are nearly finished. In the next year we aim to publish these reviews, and also to disseminate our findings, on both post-operative urinary retention and on co-production, at meetings and conferences, locally and nationally. We have already co-presented to the NIHR CLAHRC West External Advisory Panel.
We are now beginning discussions about the next stage, seeking funds to trial what we have learnt. Our research model will be co-produced, will incorporate proposals for co-production during the research process, and will additionally aim to study patient experience of post-operative urinary retention and catheterisation.