Effect of active versus passive void trials on time to patient discharge, urinary tract infection, and urinary retention: a randomized clinical trial

  • James T. Mills
  • David E. RappEmail author
  • Nathan M. Shaw
  • Helen Y. Hougen
  • Hannah E. Agard
  • Robert M. CaseJr.
  • Timothy L. McMurry
  • Noah S. Schenkman
  • Tracey L. Krupski
Original Article



We sought to determine the effect of active versus passive voiding trials on time to hospital discharge and rates of urinary tract infection (UTI) and urinary retention (UR).


We performed a prospective, randomized trial comparing active (AVT) versus passive (PVT) void trials of inpatients requiring urethral catheter removal. Of 329 eligible patients, 274 were randomized to AVT (bladder filled with saline before catheter removal) or PVT (spontaneous bladder filling after catheter removal). Primary outcome was time to hospital discharge. Secondary outcomes were UTI (NSQIP criteria) and UR (requiring repeat catheterization) within 2 weeks of void trial.


The median time to void was 18 (5–115) versus 236 (136–360) min in the AVT and PVT groups, respectively (p < 0.0001). However, no difference was seen in comparison of the median time to hospital discharge between AVT [28.4 (13.6–69.3) h] and PVT [30.0 (10.4–75.6) h] cohorts, respectively (p = 0.93). Six (4.8%) and 13 (12.9%) patients developed UTI in the AVT and PVT groups, respectively (p = 0.03). Eleven (8.8%) and 12 (11.9%) patients developed UR in the AVT and PVT groups, respectively (p = 0.36).


Our study comparing AVT versus PVT demonstrated no difference in time to discharge despite a 3.6 h reduction in time to void associated with AVT. AVT was associated with a 63% reduction in UTI, with no difference seen in UR rates across cohorts. Given the reduction in UTI and technical advantages, our data suggest that AVT should be considered as a recommended technique for void trial protocol.

Trial registration

NCT02886143 (


Void trial Discharge Urinary tract infection Urinary retention 


Author contributions

All authors have contributed sufficiently to the scientific work as follows: JTM: protocol/project development, data collection, manuscript writing, data analysis; DER: manuscript writing, data analysis; NMS: protocol/project development, data collection; HYH: protocol/project development, data collection, data analysis; HEA: protocol/project development, data collection, data analysis; RMC: protocol/project development, data collection; TLM: protocol/project development, data collection; NSS: protocol/project development, data collection, manuscript writing, data analysis; TLK: protocol/project development, data collection, manuscript writing, data analysis.



Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

University of Virginia Institutional Review Board approval was obtained prior to study initiation. All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Virginia Institutional Review Board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

345_2019_3005_MOESM1_ESM.docx (52 kb)
Supplementary material 1 (docx 65 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • James T. Mills
    • 1
  • David E. Rapp
    • 1
    Email author
  • Nathan M. Shaw
    • 2
  • Helen Y. Hougen
    • 3
  • Hannah E. Agard
    • 4
  • Robert M. CaseJr.
    • 5
  • Timothy L. McMurry
    • 6
  • Noah S. Schenkman
    • 1
  • Tracey L. Krupski
    • 1
  1. 1.Department of UrologyUniversity of VirginiaCharlottesvilleUSA
  2. 2.Department of UrologyMedStar Health Georgetown University HospitalWashingtonUSA
  3. 3.Department of UrologyOregon Health and Science UniversityPortlandUSA
  4. 4.Department of UrologyCleveland Clinic Akron GeneralAkronUSA
  5. 5.Department of MedicineUniversity of FloridaGainesvilleUSA
  6. 6.Department of Public Health SciencesUniversity of VirginiaCharlottesvilleUSA

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