Removal of Foley catheter and subsequent monitoring for spontaneous void is known as “trial without catheter.” The is currently no standard technique in doing so and the current practice is by removing the catheter and waiting for physiologic filling of bladder. Bladder infusion, involving filling up a pre-defined volume of saline into the bladder or until the patient has urge, is a technique that may reduce the time until patient is able to void and be discharged. To systematically review the evidence examining the efficacy of two modes of trial without catheter: bladder filling vs standard removal of catheter in patients who underwent surgical procedures. The primary outcome measure will be the success of TWOC. The secondary outcomes will be time-to-decision and time-to discharge.

An online database search for randomized controlled trials on bladder filling versus standard removal for trial without catheter was done. Review Manager version 5.4 was used for data analysis. Odds ratio was used for the dichotomous data and mean difference was used for continuous data. Heterogeneity was assessed with Chi Square Test and Inconsistency Index (if with substantial heterogeneity if I2 = >50%), while a random effects model was used if significant heterogeneity was present. Risk of Bias 2 tool was used to assess bias for the individual studies included. Sensitivity analysis was done on outcomes with high risk of bias and heterogeneity.

Eleven studies were included, with a total of 957 participants. TWOC is more likely to be successful in bladder filling group compared to standard removal of catheter group (OR 2.07, 95% CI 1.43-2.98, p = 0.001), without significant heterogeneity (I2 = 6%). Time-to-decision was shorter group (WMD -124.71, 95% CI -198.39 - -51.03, p = 0.0009) in the BF group than in the SR group. Time-to-discharge was noted to be significantly shorter (WMD -72.00, 95% CI -112.21 - -31.79, p = 0.0002) in BF group than SR group.

Bladder filling is a safe, simple, and efficient way to perform TWOC. It establishes bladder emptying that satisfies assessment of patient’s ability to void spontaneously.