Title

Early Catheter Removal after Pelvic Floor Reconstructive Surgery: A Randomized Trial

Document Type

Journal Article

Publication Date

11-1-2018

Journal

Obstetrical and Gynecological Survey

Volume

73

Issue

11

DOI

10.1097/OGX.0000000000000619

Abstract

© 2018 Wolters Kluwer Health, Inc. All rights reserved. Traditionally, postoperative voiding function is evaluated by performing a retrograde or a spontaneous fill voiding trial on postoperative day 1. The impact of a day-of-surgery voiding trial on postoperative urinary retention in women undergoing major pelvic reconstructive surgery has not yet been examined. The aim of this randomized, parallel-arm effectiveness trial was to determine whether a voiding trial performed on the day of surgery would result in faster time to spontaneous void, compared with a standard voiding trial performed on postoperative day 1 in women undergoing major prolapse surgery. The primary study outcome was the time to spontaneous void after the end of surgery among women randomized in an intention-to-treat analysis. Subjects were randomized to an early voiding trial 4 hours postoperatively on the day of surgery or a standard voiding trial on postoperative day 1 at 6 am. A total of 57 women were randomized: 27 to the early voiding trial and 30 to the standard voiding trial. Mean patient age was 65 ± 11 years, and body mass index was 27.9 ± 4.4 kg/m2. Most women (77.2%, 44/57) had stage III pelvic organ prolapse. Baseline characteristics were similar in groups. There was no significant difference in time to spontaneous void between groups (15.9 ± 3.8 hours in the early voiding trial group and 28.4 ± 3.1 hours in the standard trial group, P = 0.081). Multivariable regression analysis showed that an early voiding trial decreased the length of time to spontaneous void (abeta -2.00 hours, P = 0.031) after adjusting for presence of vaginal packing and preoperative stage IV prolapse. In the per-protocol analysis, which excluded 4 crossover patients, spontaneous voiding occurred 17.2 hours sooner in the early voiding trial group than the standard voiding trial group (14.6 ± 3.7 vs 31.8 ± 2.9 hours, P = 0.022).Women in the early voiding trial group ambulated sooner and more often than those in the standard group (P = 0.02). These data show that a day-of-surgery voiding trial is feasible and does not prolong catheter use among women undergoing major pelvic organ surgery.

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