Mid-urethral sling in a day surgery setting: is it possible?
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ORIGINAL ARTICLE
Mid-urethral sling in a day surgery setting: is it possible? Andrea Braga 1
&
Giorgio Caccia 1 & Luca Regusci 1 & Stefano Salvatore 2 & Andrea Papadia 3 & Maurizio Serati 4
Received: 26 June 2019 / Accepted: 16 October 2019 # The International Urogynecological Association 2019
Abstract Introduction and hypothesis Several studies have shown that immediate catheter removal following pelvic surgery is associated with several advantages. The aim of this case–control study is to compare immediate versus delayed catheter removal following mid-urethral sling surgery, to determine if indwelling catheterisation is necessary after this procedure. The secondary outcomes were subjective and objective cure rate after at least a 1-year follow-up. Methods Cases were defined as all the women who underwent a TVT Abbrevo for urodynamically proven stress incontinence. In every case the Foley catheter was removed by the surgeon at the end of the procedure. A voided volume >200 ml with a post-void residual of 30°. Women were included regardless of Q-tip test result and Valsalva leak-point pressure values. All methods, definitions and units were updated in agreement with the last version of the ICS standardization of terminology [8]. All the TVT Abbrevo procedures were performed by two expert surgeons, according to the technique originally described by Waltregny and de Leval [1]. We excluded women with a previous history of anti-incontinence or radical pelvic surgery, psychiatric and neurological disorders, concomitant vaginal prolapse >1st stage according to the POP-Q system [9]; overactive bladder (OAB) symptoms, urodynamically proven detrusor overactivity (DO) and post-void residual (PVR) >100 ml. OAB symptoms were evaluated using following questions, extrapolated from the OAB-q Short Form questionnaire [10]. After the procedure: 1. Do you have an uncomfortable urge to urinate? 2. Do you have a sudden urge to urinate with little or no warning? 3. Do you wake up at night because you had to urinate? 4. Do you have urine loss associated with a strong desire to urinate? All patients were operated on under general anaesthesia and received one dose of intra-operative prophylactic antibiotic. The bladder catheter was removed by the surgeon when the procedure was completed. Patients were encouraged to void as soon as they were alert and the urge was noted. The volume of urine drained was documented and PVR urine volumes were measured by abdominal ultrasound. A voided volume > 200 ml with a PVR < 100 ml was considered a complete
voiding trial. In/out catheterisation was performed at 4hourly intervals if the patient had not passed urine with a PVR > 100 ml. At 8 h postoperatively, in a patient who did not urinate, or sooner if they felt discomfort, or in women who were unable to void on two occasions, an indwelling catheter was placed by the nursing staff for 24 h. Patients who successfully completed the voiding trial and who did not develop any complications were discharged on the day of surgery. On postoperative day 1,
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