Voided volume for postoperative voiding assessment following prolapse and urinary incontinence surgery
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ORIGINAL ARTICLE
Voided volume for postoperative voiding assessment following prolapse and urinary incontinence surgery Nihal Z. Dolgun 1 & Keisha Jones 1 & Oz Harmanli 1,2 Received: 6 April 2020 / Accepted: 14 May 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis The objective was to compare the safety and accuracy of voided volume with the standard retrograde fill approach for voiding assessment after pelvic floor surgery. Methods This cohort represents all women in our repository who underwent postoperative voiding assessment following procedures for pelvic floor disorders between September 2011 and June 2014. One surgeon utilized a spontaneous voiding (SV) protocol and allowed any patient who voided 150 ml or more at one time to pass the trial. The other surgeon used a retrograde fill (RF) protocol. This involved instilling the bladder with 300 ml of water or until maximum capacity immediately after the outpatient procedures and on the first postoperative day for hospitalized patients. For this protocol, a voided volume of 200 ml was considered sufficient to pass the trial. Results In this cohort, 431 women had a voiding trial with SV, and 318 with RF. The groups were similar with respect to baseline characteristics but more women in the RF group had a sling-only procedure. The failure rates of the RF (22.8%) and SV (20.0%) groups were similar (p = 0.46). Among women who passed the voiding trial, similar percentages of women returned with urinary retention and needed catheter insertion after the RF (1.6%) and SV (0.9%) methods (p = 0.65). Conclusion Spontaneous voiding trial based on a minimum voided volume of 150 ml is a safe and reliable alternative to the retrograde fill method after female pelvic floor procedures. Keywords Urinary retention . Voiding dysfunction . Voiding trial . Urinary incontinence . Midurethral sling . Voiding difficulty
Introduction Voiding dysfunction following surgery for female urinary incontinence and pelvic organ prolapse (POP) can cause acute and chronic urinary retention that may lead to patient discomfort, urinary tract infections (UTIs), overflow incontinence, overactive bladder symptoms, and possibly detrusor muscle damage [1, 2]. Its incidence, which can be as high as 84%, is within the range of 25–35% in most studies [3–7]. This study was presented at the annual meeting of the Society of Gynecologic Surgeons in Orlando, Florida in 2015 * Oz Harmanli [email protected] 1
Department of Obstetrics and Gynecology, Baystate Medical Center, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
2
Department of OB/GYN/RS, Yale School of Medicine, 310 Cedar Street, FMB 329B, New Haven, CT 06510, USA
There are no universally accepted standards for postoperative voiding evaluation. As the midurethral slings became the procedure of choice for stress urinary incontinence, many practitioners moved away from prolonged suprapubic or transurethral catheter use to more liberal voiding assessment practices. To standardi
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