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J Minim Invasive Gynecol. 2019 Feb 28. pii: S1553-4650(19)30097-4. doi: 10.1016/j.jmig.2019.02.009. [Epub ahead of print]

Voiding trial in office after unsuccessful voiding trial in postoperative unit. How many more days is enough?

Author information

1
Mayo Clinic, Arizona, USA. Electronic address: Behbehani.sadikah@mayo.edu.
2
University of California San Francisco, Fresno, USA.
3
Mayo Clinic, Arizona, USA.

Abstract

STUDY OBJECTIVE:

Determine the incidence of successful in-office voiding trial after minimally invasive hysterectomy.

DESIGN:

Retrospective cohort study SETTING: Tertiary care academic center PATIENTS OR PARTICIPANTS: All patients undergoing minimally invasive hysterectomies (vaginal, laparoscopic, or robotic) from January 2013 to July 2018 who have unsuccessful voiding trial in the post-operative unit INTERVENTIONS: Voiding trial MEASUREMENTS AND MAIN RESULTS: Out of 558 outpatient hysterectomies (with same day discharge) performed in the time period of interest, 174 patients were discharged home with a Foley catheter (31%). Out of those patients, 37% presented for a repeat in office voiding trial at less than 3 postoperative days, 31% presented at 3 postoperative days and 31.6% presented at more than 3 postoperative days. Eighty six percent of patients presenting for their first in office voiding trial were successful at voiding. There were no differences noted in age, gravity, parity, use of hormone replacement therapy, menopausal status, smoking, hypertension, or diabetes in patients who passed their first in office voiding trial compared to those who did not. Vaginal hysterectomy was the most common route of hysterectomy and was performed in 57% of cases, followed by robotic hysterectomy in 32%. There were no differences noted in the indication or route of hysterectomy between patients who pass or fail their first in-office voiding trial. At the time of hysterectomy, 47% of patients had concomitant Female Pelvic Medicine and Reconstructive Surgery (FPMRS) procedures performed (midurethral sling, peri-urethral injections, or colporrhaphy). The incidence of urinary tract infection in this patient cohort was 12%, but the incidence of was significantly higher in patients who failed compared to those who passed their first in office voiding trial (37.3% vs. 7.3%, p value <0.001). After adjusting for age, hysterectomy route, and concomitant FPMRS procedures performed, the number of postoperative days at time of first in-office voiding trial does not predict success.

CONCLUSION:

The timing of repeat in office voiding trial in post-hysterectomy patients who fail their initial voiding trial in PACU was not related to success. The incidence of urinary tract infection is higher in patients who fail their repeat voiding trial, as re-catheterization, and longer duration of catherization, is necessary.

KEYWORDS:

minimally invasive hysterectomy; outpatient hysterectomy; urinary retention; voiding trial

PMID:
30826451
DOI:
10.1016/j.jmig.2019.02.009

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