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Wang F, Wang X, Shi Y, Li L, Zheng Y, Liu H, Zeng M, Jiang F, Wu Z. Development of a risk nomogram predicting urinary tract infection in patients with indwelling urinary catheter after radical surgery for cervical cancer. Prog Urol 2023; 33:492-502. [PMID: 37634960 DOI: 10.1016/j.purol.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/06/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Cervical cancer (CC) patients receiving indwelling catheterization after radical hysterectomy (RH) are vulnerable to urinary tract infection (UTI). However, no model or method is available to predict the risk of UTIs. Therefore, our aim was to develop and verify a risk model to predict UTI for patients receiving indwelling catheterization after radical cervical cancer surgery (ICa-RCCS). METHODS We first collected clinical information of 380 patients receiving ICa-RCCS from January 2020 to December 2021 as a training cohort to develop the risk nomogram. UTI was then evaluated using 19 UTI predictor factors. The least absolute shrinkage and selection operator (LASSO) method was utilized for the extraction characteristics. Multivariable logistic regression analysis was then conducted to create the risk model for UTI prediction. The consistency coefficient and calibration curve were utilized to assess the model's fit accuracy. We performed bootstrapping with 1000 random samples for internal validation of the model, and decision curve analysis (DCA) for clinical application. RESULTS Predictors in the risk nomogram included indwelling catheterization duration, whether it is secondary indwelling catheterization, history of UTIs, age, and history of chemotherapy before surgery. The risk nomogram presented good discrimination and calibration (C-index: 0.810, 95% CI: 0.759-0.861). During interval validation, the model reached a high C-index up to 0.7930. DCA revealed the clinical utility of predictive model for UTI. Clinical benefit was initiated at the decision threshold≥3%. CONCLUSION We developed a novel UTI nomogram incorporating the age, history of chemotherapy before surgery, indwelling catheterization duration, whether it is secondary indwelling catheterization, and history of UTI to predict UTI risk for patients receiving ICa-RCCS. LEVEL OF EVIDENCE B: 3a.
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Affiliation(s)
- Fang Wang
- Chong Qing Three Gorges Medical College, Chongqing, China
| | - Xiaoli Wang
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - YuanXiang Shi
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Ling Li
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Yu Zheng
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Huaying Liu
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Min Zeng
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Feng Jiang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fu dan University, Shanghai, China.
| | - Zhimin Wu
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China.
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Byford S, Madhok D, Baldan P, Amey G, Barber J, Harris R, Walker G. Introduction of the day case total laparoscopic hysterectomy (TLH) protocol. Aust N Z J Obstet Gynaecol 2022; 62:881-886. [PMID: 35906724 DOI: 10.1111/ajo.13598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Traditionally total laparoscopic hysterectomy (TLH) patients are admitted for 1-2 days post-operatively. Day case TLH has been proven to be feasible and safe in other countries; however, this tertiary Queensland hospital is one of the first Australian institutions to introduce a day case TLH protocol. AIM To pilot the implementation of our day case TLH protocol assessing the feasibility, safety and patient satisfaction of same-day discharge. MATERIALS AND METHODS A retrospective audit of the implementation of our day case TLH protocol at a tertiary Queensland hospital was conducted. Primary outcome was length of post-operative hospital stay. Secondary outcomes included perioperative complications and post-operative re-presentation rates. Patient satisfaction was assessed through a patient questionnaire. RESULTS Seventy-seven patients were included in the study. There were 94.81% patients who went home on the same day. Their average length of post-operative hospital stay was 7.72 (SD ± 3.36) hours. Of the patients who did achieve same-day discharge, the average length of stay was 7.05 (SD ±1.46) hours. There were no significant differences in perioperative complications or re-presentation rates compared to previously published literature. Patients reported they were extremely satisfied with day case TLH. CONCLUSION The implementation of our day case TLH protocol is feasible, safe and well received by patients in our tertiary Australian hospital. These results can have multimodal effects in healthcare: decrease in hospital costs by reducing length of stay and overnight admissions, improved theatre efficiency and patient flow, while maintaining patient safety and satisfaction.
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Affiliation(s)
- Sally Byford
- Obstetrics and Gynaecology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Drishti Madhok
- Obstetrics and Gynaecology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Paula Baldan
- Obstetrics and Gynaecology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Guy Amey
- Anesthetics, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - James Barber
- Obstetrics and Gynaecology, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Rhys Harris
- Obstetrics and Gynaecology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Graeme Walker
- Obstetrics and Gynaecology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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Fu CY, Wan L, Shen PY, Wang LZ. Feasibility of immediate removal of urinary catheter after laparoscopic gynecological surgery for benign diseases: A meta-analysis of randomized controlled trials. Int J Gynaecol Obstet 2022; 159:622-629. [PMID: 35616374 DOI: 10.1002/ijgo.14283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/09/2022] [Accepted: 05/10/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The proper time for removing the urinary catheter after gynecologic laparoscopy is unclear. OBJECTIVES To assess the feasibility of immediate catheter removal after benign gynecologic laparoscopy. SEARCH STRATEGY PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Wanfang Data were searched from inception to November 30, 2021. SELECTION CRITERIA Only randomized controlled trials published in English or Chinese comparing immediate versus delayed catheter removal after gynecologic laparoscopy for benign diseases were included. DATA COLLECTION AND ANALYSIS The primary outcome was the incidence of postoperative urinary retention (PUR). A random effects model was used to calculate pooled relative risk (RR) and 95% confidence interval (CI). MAIN RESULTS Six studies were included in this meta-analysis. There was no significant difference in PUR between immediate and delayed catheter removal (RR 1.51, 95% CI 0.37-6.18), but the evidence was of very low quality. Subgroup analysis according to the type of surgery showed a higher rate of PUR with immediate removal after hysterectomy than after other surgeries. Immediate removal was associated a lower incidence of urinary tract infection and a shorter time to mobilization compared with delayed removal. CONCLUSIONS Immediate removal of the urinary catheter is feasible and beneficial after benign gynecologic laparoscopy.
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Affiliation(s)
- Chun-Yan Fu
- Department of Gynecologic Nursing, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital, Jiaxing University, Jiaxing, Zhejiang, China
| | - Li Wan
- Department of Gynecologic Nursing, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital, Jiaxing University, Jiaxing, Zhejiang, China
| | - Pei-Ying Shen
- Department of Gynecologic Nursing, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital, Jiaxing University, Jiaxing, Zhejiang, China
| | - Li-Zhong Wang
- Department of Anesthesiology, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital, Jiaxing University, Jiaxing, Zhejiang, China
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Anglim BC, Tomlinson G, Paquette J, McDermott CD. A risk calculator for postoperative urinary retention (POUR) following vaginal pelvic floor surgery: multivariable prediction modelling. BJOG 2022; 129:2203-2213. [PMID: 35596931 DOI: 10.1111/1471-0528.17225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 04/07/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the perioperative characteristics associated with an increased risk of postoperative urinary retention (POUR) following vaginal pelvic floor surgery. DESIGN A retrospective cohort study using multivariable prediction modelling. SETTING A tertiary referral urogynaecology unit. POPULATION Patients undergoing vaginal pelvic floor surgery from January 2015 to February 2020. METHODS Eighteen variables (24 parameters) were compared between those with and without POUR and then included as potential predictors in statistical models to predict POUR. The final model was chosen as the model with the largest concordance index (c-index) from internal cross-validation. This was then externally validated using a separate data set (n = 94) from another surgical centre. MAIN OUTCOME MEASURE Diagnosis of POUR following surgery while the patient was in hospital. RESULTS Among the 700 women undergoing surgery, 301 (43%) experienced POUR. Preoperative variables with statistically significant univariate relationships with POUR included age, menopausal status, prolapse stage and uroflowmetry parameters. Significant perioperative factors included estimated blood loss, volume of intravenous fluid administered, operative time, length of stay and specific procedures, including vaginal hysterectomy with intraperitoneal vault suspension, anterior colporrhaphy, posterior colporrhaphy and colpocleisis. The lasso logistic regression model had the best combination of internally cross-validated c-index (0.73, 95% CI 0.71-0.74) and a calibration curve that showed good alignment between observed and predicted risks. Using this data, a POUR risk calculator was developed (https://pourrisk.shinyapps.io/POUR/). CONCLUSIONS This POUR risk calculator will allow physicians to counsel patients preoperatively on their risk of developing POUR after vaginal pelvic surgery and help focus discussion around potential management options.
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Affiliation(s)
- Breffini C Anglim
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - George Tomlinson
- Department of Medicine, University Health Network and Mt Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Joalee Paquette
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Colleen D McDermott
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Lin T, Ting PTY, Sanders AP, Belland L. Urinary Retention After Laparoscopic Definitive Surgery for Stages III and IV Endometriosis Without Explicit Nerve-Sparing Techniques: A Retrospective Analysis. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tinya Lin
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Paxton Tsz Yeung Ting
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Ari P. Sanders
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Peter Lougheed Centre, University of Calgary, Calgary, Alberta, Canada
| | - Liane Belland
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Peter Lougheed Centre, University of Calgary, Calgary, Alberta, Canada
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Chen SF, Wang PH, Kuo SC, Chen YC, Sia HJ, Lee PH, Yang JH, Kao S. Early and Standard Urinary Catheter Removal After Gynecological Surgery for Benign Lesions: A Quasi-Experimental Study. Clin Nurs Res 2021; 31:489-496. [PMID: 34514876 DOI: 10.1177/10547738211044500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients undergoing gynecological surgery commonly receive indwelling transurethral Foley catheters, however duration of catheterization is associated with risk of urinary tract infections and other adverse effects. Early removal of catheters is encouraged, however optimal timing postsurgery remains unclear. This quasi-experimental study compared outcomes for women after removal of a Foley catheter at two different times following benign gynecological surgery. Participants received either early catheter removal, within 6 hours of surgery (n = 38) or standard catheter removal, within 12 to 24 hours of surgery (n = 45). There were no significant differences in outcomes for discomfort scores or re-catheterization rates between groups. However, the early removal group had a significantly shorter time to first ambulation and shorter hospital stays. Early removal of Foley catheters in patients who underwent gynecological surgery did not increase adverse events. Early removal of catheters after gynecological surgery may decrease re-catheterization rates and increase patient satisfaction.
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Affiliation(s)
- Shu Fen Chen
- Taipei Veterans General Hospital, Taipei.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei
| | - Peng-Hui Wang
- Taipei Veterans General Hospital, Taipei.,National Yang Ming Chiao Tung University, Taipei.,China Medical University Hospital, Taichung.,The Female Cancer Foundation, Taipei
| | - Shu-Chen Kuo
- Taipei Veterans General Hospital, Taipei.,National Yang Ming Chiao Tung University, Taipei
| | | | | | | | | | - Senyeong Kao
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei
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Chapman GC, Sheyn D, Slopnick EA, Roberts K, El-Nashar SA, Henderson JW, Mangel J, Hijaz AK, Pollard RR, Mahajan ST. Tamsulosin vs placebo to prevent postoperative urinary retention following female pelvic reconstructive surgery: a multicenter randomized controlled trial. Am J Obstet Gynecol 2021; 225:274.e1-274.e11. [PMID: 33894146 DOI: 10.1016/j.ajog.2021.04.236] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Postoperative urinary retention is common after female pelvic reconstructive surgery. Alpha receptor antagonists can improve dysfunctional voiding by relaxing the bladder outlet and may be effective in reducing the risk of postoperative urinary retention. OBJECTIVE This study aimed to determine whether tamsulosin is effective in preventing postoperative urinary retention in women undergoing surgery for pelvic organ prolapse. STUDY DESIGN This was a multicenter, double-blind, randomized controlled trial between August 2018 and June 2020, including women undergoing surgery for pelvic organ prolapse. Patients were excluded from recruitment if they had elevated preoperative postvoid residual volume, history of postoperative urinary retention, or a contraindication to tamsulosin. Those who experienced cystotomy were excluded from analysis. Participants were randomized to a 10-day perioperative course of tamsulosin 0.4 mg vs placebo, beginning 3 days before surgery. A standardized voiding trial was performed on postoperative day 1. The primary outcome was the development of postoperative urinary retention, as defined by the failure of the voiding trial or subsequent need for catheterization to empty the bladder. Secondary outcomes included the rate of urinary tract infection and the impact on lower urinary tract symptoms as measured by the American Urological Association Symptom Index. RESULTS Of 119 patients, 57 received tamsulosin and 62 received placebo. Groups were similar in regard to demographics, preoperative prolapse and voiding characteristics, and surgical details. Tamsulosin was associated with a lower rate of postoperative urinary retention than placebo (5 patients [8.8%] vs 16 patients [25.8%]; odds ratio, 0.28; 95% confidence interval, 0.09-81; P=.02). The number needed to treat to prevent 1 case of postoperative urinary retention was 5.9 patients. The rate of urinary tract infection did not differ between groups. American Urological Association Symptom Index scores significantly improved after surgery in both groups (median total score, 14 vs 7; P<.01). Scores related to urinary stream improved more in the tamsulosin group than in placebo (P=.03). CONCLUSION In this placebo-controlled trial, tamsulosin use was associated with a reduced risk of postoperative urinary retention in women undergoing surgery for pelvic organ prolapse.
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Delgado S, Wright KN, Jan A, Vogell AB. Incidence and Risk Factors for Urinary Retention in Patients Undergoing Outpatient Hysterectomy. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Ambareen Jan
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
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9
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Zhang BY, Wong JMH, A Koenig N, Lee T, Geoffrion R. Risk factors for urinary retention after urogynecologic surgery: A retrospective cohort study and prediction model. Neurourol Urodyn 2021; 40:1182-1191. [PMID: 33891339 DOI: 10.1002/nau.24676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 01/22/2021] [Accepted: 03/29/2021] [Indexed: 11/06/2022]
Abstract
AIMS Postoperative urinary retention (POUR) is a common complication of urogynecological surgery. Our study aimed to identify demographic and perioperative risk factors to construct a prediction model for POUR in urogynecology. METHODS Our retrospective cohort study reviewed all patients undergoing pelvic reconstructive surgeries at our tertiary care center (Jan 1, 2013-May 1, 2019). Demographic, pre-, intra- and postoperative variables were collected from medical records. The primary outcome, POUR, was defined as (1) early POUR (E-POUR), failing initial trial of void or; (2) late POUR (L-POUR), requiring an indwelling catheter or intermittent catheterization on discharge. Risk factors were identified through univariate and multivariate logistic regression analyses. A clinical prediction model was constructed with the most significant and clinically relevant risk factors. RESULTS In 501 women, 182 (36.3%) had E-POUR and 61 of these women (12.2% of the entire cohort) had L-POUR. Multivariate logistic regression revealed preoperative postvoid residual (PVR) over 200 ml (odds ratio [OR]: 3.17; p = 0.026), voiding dysfunction symptoms extracted from validated questionnaires (OR: 3.00; p = 0.030), and number of concomitant procedures (OR: 1.30 per procedure; p = 0.021) as significant predictors of E-POUR; preoperative PVR more than 200 ml (OR: 4.07; p = 0.011) and antiincontinence procedure with (OR: 3.34; p = 0.023) and without (OR: 2.64; p = 0.019) concomitant prolapse repair as significant predictors of L-POUR. A prediction model (area under the curve: 0.70) was developed for E-POUR. CONCLUSIONS Elevated preoperative PVR is the most significant risk factor for POUR. Alongside other risk factors, our prediction model for POUR can be used for patient counseling and surgical planning in urogynecologic surgery.
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Affiliation(s)
- Bei Yuan Zhang
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey Man Hay Wong
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole A Koenig
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Terry Lee
- Center for Health Evaluation & Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roxana Geoffrion
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
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Klebanoff JS, Barnes WA, Kazma J, Ingraham CF, Mangini MG, Nishikawa MI, Goldstein NM, Tyan P, Moawad GN. Patterns of voiding following laparoscopic hysterectomy. J Gynecol Obstet Hum Reprod 2021; 50:102126. [PMID: 33775918 DOI: 10.1016/j.jogoh.2021.102126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/22/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Clarify the normal patterns of voiding after minimally invasive hysterectomy. We also aim to identify perioperative factors associated with delayed time to void immediately following hysterectomy. DESIGN Retrospective cohort study SELECTION: Women undergoing laparoscopic hysterectomy between September 2012 to October 2018 at a single academic university hospital. RESULTS 450 minimally invasive hysterectomies were included in the final analysis, 274 (60.9%) robotically-assisted, and 176 (39.1%) conventional laparoscopy. The overall median postoperative time-to-void following a retrograde bladder filling of 150 mL normal saline was 179 min. Based on the 50th percentile of the distribution of the time-to-void, two groups were created. Demographic characteristics between the groups were similar, except those who were above the 50th percentile were more likely to be older, have a reported history of previous myomectomy, and had a longer postoperative PACU stay compared to those below or equal to the 50th percentile. The mean time-to-void following conventional laparoscopic hysterectomy was less than that of robotic surgery (187.3 vs 200.5 min) however the difference was not statistically significant (p=.22). The use of hydromorphone intraoperatively and the combination of oxycodone-acetaminophen postoperatively were more likely to be associated with the group of patients above the 50th percentile but there was no significant difference in perioperative utilization of median morphine milliequivalents (MME) between the two groups. CONCLUSIONS Following laparoscopic hysterectomy (either conventional or with robotic-assistance) with a retrograde bladder fill of 150 mL normal saline most patients will void within 4 h after surgery. This is consistent with historic data on normal voiding patterns facilitating safe same day discharge without prolonged time in the PACU.
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Affiliation(s)
- Jordan S Klebanoff
- Department of Obstetrics and Gynecology, The George Washington University Hospital, 900 23rd Street NW, Washington, DC 20037, USA
| | - Whitney A Barnes
- Department of Obstetrics and Gynecology, The George Washington University Hospital, 900 23rd Street NW, Washington, DC 20037, USA
| | - Jamil Kazma
- Department of Obstetrics and Gynecology, The George Washington University Hospital, 900 23rd Street NW, Washington, DC 20037, USA
| | - Caitlin F Ingraham
- Department of Obstetrics and Gynecology, Christiana Care Health System, 4755 Ogletown-Stanton Road, Newark, DE 19718 - USA
| | - Marissa G Mangini
- The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC 20052 - USA
| | - Moena I Nishikawa
- The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC 20052 - USA
| | - Naomi M Goldstein
- The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC 20052 - USA
| | - Paul Tyan
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, The University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - Gaby N Moawad
- Department of Obstetrics and Gynecology, The George Washington University Hospital, 900 23rd Street NW, Washington, DC 20037, USA.
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Siedhoff MT, Wright KN, Misal MA, Molina AL, Greene NH. Postoperative Urinary Retention after Benign Gynecologic Surgery with a Liberal versus Strict Voiding Protocol. J Minim Invasive Gynecol 2021; 28:351-357. [PMID: 32652242 PMCID: PMC7790839 DOI: 10.1016/j.jmig.2020.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 01/04/2023]
Abstract
STUDY OBJECTIVE Surgeons employ various methods for evaluating what is considered a common occurrence after gynecologic operations, postoperative urinary retention (POUR). Few have reported the incidence of POUR with a liberal voiding protocol (no requirement to void before discharge). The primary objective of this study was to evaluate the risk of POUR after benign gynecologic surgery, comparing a liberal voiding protocol with more strict voiding protocols. Secondary outcomes included length of hospital stay (LOS) and urinary tract infection (UTI). DESIGN Retrospective cohort study. SETTING Quaternary-care academic hospital in the United States. PATIENTS Patients undergoing hysterectomy or myomectomy at Cedars-Sinai Medical Center from August 2017 through July 2018 (n = 652). Cases involving incontinence operations, correction of pelvic organ prolapse, malignancy, or peripartum hysterectomy were excluded. INTERVENTIONS Hysterectomy, myomectomy. MEASUREMENTS AND MAIN RESULTS POUR, defined as the need for recatheterization within 24 hours of catheter removal, along with UTI and LOS were compared between liberal and strict voiding protocols. A subgroup analysis was performed for those undergoing minimally invasive surgery (MIS). A total of 303 (46.5%) women underwent surgery with a liberal postoperative voiding protocol and 349 (53.5%) women with a strict voiding protocol. Overall, the incidence of POUR was low at 3.8% and not different between the groups (2.6% liberal vs. 4.9% strict, p = .14). UTIs also occurred infrequently (2.8% overall, 2.6% liberal vs. 2.9% strict, p = .86). Similar results were seen specifically among those who underwent MIS: POUR (3.7% overall, 2.8% liberal vs. 5.3% strict, p = .17) and UTI (3.3% overall, 2.4% liberal vs. 4.7% strict, p = .28). The median LOS (interquartile range) was much shorter for MIS patients with a liberal voiding protocol (median 15 hours overall [interquartile range 15 hours], 9 [4] hours liberal vs. 36 [34] hours strict, p <.01). Among those discharged the same day (72.6% of the MIS cases), patients with a liberal voiding protocol had a significantly shorter LOS than those with strict (mean [standard deviation] 9.4 [2.5] hours vs. 10.6 [35] hours, p <.01). Postoperative complications occurred less frequently in those with MIS procedures (11.8% in MIS vs. 20.2% in laparotomies, p <.01) and those with liberal voiding protocols (11.2% liberal vs. 16.9% strict p = .04). CONCLUSION Overall, POUR occurs infrequently after major benign gynecologic surgery and does not differ between those with liberal and strict voiding protocols. Our data suggest that same-day discharge after MIS hysterectomy and myomectomy without a requirement to void does not increase the risk of POUR and shortens LOS. Eliminating voiding protocols after these procedures may facilitate greater efficiency in the postanesthesia recovery unit and may contribute to enhanced recovery after surgery protocols.
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Affiliation(s)
- Matthew T Siedhoff
- Department of Obstetrics & Gynecology (all authors); Division of Minimally Invasive Gynecologic Surgery (Drs. Siedhoff and Wright), Cedars-Sinai Medical Center, Los Angeles, California.
| | - Kelly N Wright
- Department of Obstetrics & Gynecology (all authors); Division of Minimally Invasive Gynecologic Surgery (Drs. Siedhoff and Wright), Cedars-Sinai Medical Center, Los Angeles, California
| | - Meenal A Misal
- Department of Obstetrics & Gynecology (all authors); Division of Minimally Invasive Gynecologic Surgery (Drs. Siedhoff and Wright), Cedars-Sinai Medical Center, Los Angeles, California
| | - Andrea L Molina
- Department of Obstetrics & Gynecology (all authors); Division of Minimally Invasive Gynecologic Surgery (Drs. Siedhoff and Wright), Cedars-Sinai Medical Center, Los Angeles, California
| | - Naomi H Greene
- Department of Obstetrics & Gynecology (all authors); Division of Minimally Invasive Gynecologic Surgery (Drs. Siedhoff and Wright), Cedars-Sinai Medical Center, Los Angeles, California
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12
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Predictors of Urinary Retention After Vesicovaginal Fistula Surgery: A Retrospective Case-Control Study. Female Pelvic Med Reconstr Surg 2020; 26:726-730. [PMID: 30681420 DOI: 10.1097/spv.0000000000000694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The objective of this study is to determine the predictors for urinary retention after vesicovaginal fistula surgery. METHODS This was a retrospective case-control study of women who underwent vesicovaginal fistula repair between January 2014 and December 2017 at the Fistula Care Centre in Lilongwe, Malawi. Cases were defined as patients with documented urinary retention, defined as a postvoid residual that is 50% greater than the total void of at least 100 mL. The cases and controls were matched by the 3 components of the Goh classification system in a ratio of 1:5. Univariate analysis was used to detect differences between demographic, clinical characteristics, and operative techniques between cases and control. Logistic regression analysis was performed for estimation of odds ratios (ORs). RESULTS There were no statistically significant differences between the 40 cases and 187 controls, when comparing age, gravidity, parity, body mass index, and length of postoperative catheterization. The median amount of postvoid residual noted at the time of diagnosis was 240 mL (range, 55-927 mL). Odds for urinary retention was 3 times higher among those with vertical closure than patients with horizontal closure of the bladder (OR, 2.91; 95% confidence interval, 1.35-6.20). Patients with prior fistula repairs were significantly less likely to develop urinary retention compared to those receiving surgery for the first time (OR, 0.27; 95% confidence interval, 0.10-0.67). CONCLUSIONS Vertical closure of the bladder and patients without a history of prior fistula repairs are predictors for developing urinary retention after fistula repair surgery.
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Misal M, Behbehani S, Yang J, Wasson MN. Is Hysterectomy a Risk Factor for Urinary Retention? A Retrospective Matched Case Control Study. J Minim Invasive Gynecol 2020; 27:1598-1602. [DOI: 10.1016/j.jmig.2020.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/22/2020] [Accepted: 02/25/2020] [Indexed: 11/16/2022]
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Zakhari A, Paek W, Chan W, Edwards D, Matelski J, Solnik MJ, Murji A. Retrograde Bladder Filling after Laparoscopic Gynecologic Surgery: A Double-blind Randomized Controlled Trial. J Minim Invasive Gynecol 2020; 28:1006-1012.e1. [PMID: 33017685 PMCID: PMC7532349 DOI: 10.1016/j.jmig.2020.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 11/27/2022]
Abstract
Study Objective To evaluate whether retrofilling the bladder on completion of elective laparoscopic gynecologic surgery for benign indications has an effect on the timing of the first postoperative void and the timing of discharge from the hospital. Design Double-blind randomized controlled trial. Setting Single academic surgical day hospital. Patients Patients undergoing outpatient laparoscopic gynecologic surgery, excluding hysterectomy or pelvic reconstructive surgery. Interventions On completion of surgery, patients were randomized to either retrograde filling of the bladder with 200 mL of saline before catheter removal or standard care (immediate catheter removal). Patients and postanesthesia care unit nurses (outcome assessors) were both blinded. Measurements and Main Results The primary outcome was the time to first void. The secondary outcomes were time to hospital discharge, postoperative urinary tract infection, and patient satisfaction. Over a 3-month period, 47 patients were approached on the day of surgery, 42 consented and were randomized (21 to intervention and 21 to control). There were no significant differences in baseline demographics between the groups. The median time to first void was significantly shorter for patients in the intervention arm than controls (104 ± 75 minutes vs 162 ± 76 minutes, p <.001). Patients who had retrofilled bladders were discharged faster from post-anesthesia care unit compared to controls (155.0 ± 74 minutes vs 227 ± 58 minutes, p = .001). There were no urinary tract infections in either group, and the proportion of satisfied or very satisfied patients was high (93.8% vs 88.2%, p = .512). Conclusion Retrograde filling of the bladder after outpatient laparoscopic gynecologic surgery is a safe, effective method that significantly reduces the length of hospital stay.
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Affiliation(s)
- Andrew Zakhari
- Department of Obstetrics and Gynecology, Mount Sinai Hospital (Drs. Zakhari, Paek, Chan, Edwards, Solnik, and Murji); Department of Obstetrics & Gynecology, University of Toronto (Drs. Zakhari, Paek, Chan, Edwards, Solnik, and Murji); Department of XXX, McGill University Health Center, Montreal, Quebec (Dr. Zakhari), Canada
| | - Wusun Paek
- Department of Obstetrics and Gynecology, Mount Sinai Hospital (Drs. Zakhari, Paek, Chan, Edwards, Solnik, and Murji); Department of Obstetrics & Gynecology, University of Toronto (Drs. Zakhari, Paek, Chan, Edwards, Solnik, and Murji)
| | - Wilson Chan
- Department of Obstetrics and Gynecology, Mount Sinai Hospital (Drs. Zakhari, Paek, Chan, Edwards, Solnik, and Murji); Department of Obstetrics & Gynecology, University of Toronto (Drs. Zakhari, Paek, Chan, Edwards, Solnik, and Murji)
| | - Darl Edwards
- Department of Obstetrics and Gynecology, Mount Sinai Hospital (Drs. Zakhari, Paek, Chan, Edwards, Solnik, and Murji); Department of Obstetrics & Gynecology, University of Toronto (Drs. Zakhari, Paek, Chan, Edwards, Solnik, and Murji)
| | - John Matelski
- Biostatistics Research Unit, University Health Network (Dr. Matelski), Toronto, Ontario
| | - M Jonathon Solnik
- Department of Obstetrics and Gynecology, Mount Sinai Hospital (Drs. Zakhari, Paek, Chan, Edwards, Solnik, and Murji); Department of Obstetrics & Gynecology, University of Toronto (Drs. Zakhari, Paek, Chan, Edwards, Solnik, and Murji)
| | - Ally Murji
- Department of Obstetrics and Gynecology, Mount Sinai Hospital (Drs. Zakhari, Paek, Chan, Edwards, Solnik, and Murji); Department of Obstetrics & Gynecology, University of Toronto (Drs. Zakhari, Paek, Chan, Edwards, Solnik, and Murji).
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Farag S, Padilla PF, Smith KA, Zimberg SE, Sprague ML. Postoperative Urinary Retention Rates after Autofill versus Backfill Void Trial following Total Laparoscopic Hysterectomy: A Randomized Controlled Trial. J Minim Invasive Gynecol 2020; 28:829-837. [PMID: 32712322 DOI: 10.1016/j.jmig.2020.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/02/2020] [Accepted: 07/20/2020] [Indexed: 01/18/2023]
Abstract
STUDY OBJECTIVE To compare the rate of postoperative urinary retention (POUR) after total laparoscopic hysterectomy (TLH) using the autofill vs the backfill void trial. Secondary objectives were to compare the time to discharge from the recovery room, rate of postoperative urinary tract infection (UTI), perceived bladder condition, the effect of bladder function on life, and patient satisfaction. DESIGN Randomized controlled trial. SETTING Single academic medical center. PATIENTS Women who underwent TLH by conventional laparoscopy or robotic-assisted laparoscopy for benign non-urogynecologic indications. INTERVENTIONS After TLH, participants were randomized to have an autofill void trial (group A) or a backfill void trial once they were able to ambulate (group B). Failure rate, time to discharge, and UTI rate were assessed. Participants completed the patient perception of bladder condition and the incontinence impact questionnaire-short form questionnaires. Patient satisfaction was assessed. Multiple regression analysis was performed to determine the predictors of POUR. MEASUREMENTS AND MAIN RESULTS Eighty-two participants completed the study after randomization, 42 in group A and 40 in group B. There were no statistically significant differences in demographic or perioperative outcomes. Seven participants had POUR in group A (16.7%) and 11 in group B (27.5%) (p = .36), respectively. The median time to discharge was 176 minutes for group A (160.5, 255.5) and 218 minutes for group B (180, 265) (p = .01), respectively. There were no statistically significant differences in rate of postoperative UTI (p >.99), patient perception of bladder condition scores (p = .24), incontinence impact questionnaire-short form scores (p = .23), and patient satisfaction scores (p = .26). A stepwise logistic regression analysis did not demonstrate any predictors of POUR. CONCLUSION Backfill void trial once the participant was able to ambulate was not superior to the autofill void trial with respect to the rate of POUR. The autofill void trial resulted in faster same-day discharge.
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Affiliation(s)
- Sara Farag
- Division of Gynecology, Cleveland Clinic Florida, Weston, Florida (all authors)..
| | | | - Katherine A Smith
- Division of Gynecology, Cleveland Clinic Florida, Weston, Florida (all authors)
| | - Stephen E Zimberg
- Division of Gynecology, Cleveland Clinic Florida, Weston, Florida (all authors)
| | - Michael L Sprague
- Division of Gynecology, Cleveland Clinic Florida, Weston, Florida (all authors)
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Frishman GN. Do We Need to Follow Doctor's Order to Void before Discharge after Same Day Surgery? J Minim Invasive Gynecol 2020; 27:985. [DOI: 10.1016/j.jmig.2020.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 12/28/2022]
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Patient Discharge without an Order to Void in the Outpatient Gynecologic Surgery Setting. J Minim Invasive Gynecol 2020; 27:1059-1062. [DOI: 10.1016/j.jmig.2019.09.770] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 02/06/2023]
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Smith RB, Mahnert ND, Hu C, Steck-Bayat K, Womack AS, Mourad J. Impact of Retained Cystoscopy Fluid after Laparoscopic Hysterectomy: A Randomized Controlled Trial. J Minim Invasive Gynecol 2020; 28:288-296. [PMID: 32505857 DOI: 10.1016/j.jmig.2020.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE To investigate the impact of retained cystoscopy fluid after laparoscopic hysterectomy on time to spontaneous void, time to discharge, urinary retention, bladder discomfort, and patient satisfaction. DESIGN Single-blind randomized controlled trial. SETTING An academic medical center. PATIENTS One hundred and twenty patients who underwent laparoscopic hysterectomy with universal cystoscopy for benign indications, excluding pelvic organ prolapse and urinary incontinence indications. INTERVENTIONS From October 10, 2018, to October 17, 2019, we compared 200 mL retained cystoscopy fluid and complete bladder emptying after laparoscopic hysterectomy with universal cystoscopy. MEASUREMENTS AND MAIN RESULTS A total of 120 patients were enrolled and randomized (59 in the retained cystoscopy fluid group and 61 in the emptied fluid group). The primary outcome was time to first spontaneous void. The secondary outcomes were time to discharge, urinary retention rates, bladder discomfort, and patient satisfaction. A sample size of 120 was calculated to detect a 57-minute difference in time to spontaneous void. There were minimal differences in baseline demographics and surgical characteristics between the groups. There was an apparent, although not significant, difference in time to void of 25 minutes (143 minutes vs 168 minutes, p = .20). Time to discharge and urinary retention rates did not differ (199 minutes vs 214 minutes, p = .40, and 13.6% vs 8.2%, p = .51, respectively). There was no difference in postoperative bladder discomfort and patient satisfaction. CONCLUSION Retained cystoscopy fluid after laparoscopic hysterectomy did not significantly affect time to first spontaneous void, time to discharge, urinary retention, bladder discomfort, or patient satisfaction.
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Affiliation(s)
- Rachael B Smith
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Banner-University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix (Drs. Smith, Mahnert, Steck-Bayat, Womack, and Mourad).
| | - Nichole D Mahnert
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Banner-University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix (Drs. Smith, Mahnert, Steck-Bayat, Womack, and Mourad)
| | - Chengcheng Hu
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (Dr. Hu), Arizona
| | - Kayvahn Steck-Bayat
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Banner-University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix (Drs. Smith, Mahnert, Steck-Bayat, Womack, and Mourad)
| | - Ashley S Womack
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Banner-University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix (Drs. Smith, Mahnert, Steck-Bayat, Womack, and Mourad)
| | - Jamal Mourad
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Banner-University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix (Drs. Smith, Mahnert, Steck-Bayat, Womack, and Mourad)
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Immediate catheter removal after laparoscopic hysterectomy: A retrospective analysis. Eur J Obstet Gynecol Reprod Biol 2020; 250:76-79. [PMID: 32402943 DOI: 10.1016/j.ejogrb.2020.04.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES All patients undergoing a laparoscopic hysterectomy receive an indwelling catheter during surgery. The optimum timing of removal of the catheter is uncertain. A possible advantage of leaving the catheter in up to 12 h after surgery is to reduce the risk of urinary retention. Possible disadvantages are patient discomfort and increased risk of urinary tract infection. Timing of removal of the catheter after laparoscopic hysterectomy has not been studied. Previous studies have assessed timing of catheter removal after abdominal hysterectomy. In these studies immediate removal seems safe and feasible after an uncomplicated hysterectomy. In 2015 immediate catheter removal after an uncomplicated hysterectomy was introduced in our clinic. We performed a retrospective analysis of all patients who underwent a laparoscopic hysterectomy. The primary objective of this study was to evaluate the rate of urinary retentions and the secondary objective was to investigate the rate of urinary tract infections when the indwelling catheter was removed immediate after surgery. STUDY DESIGN We included all women who underwent a laparoscopic hysterectomy from April 2015 until December 2017. Informed consent was obtained from all patients. Medical records were analysed to identify baseline characteristics, surgical details and complications. General practitioners of the included patients were contacted to check for post-operative urinary tract infection up to 6 weeks after surgery. RESULTS 325 patients underwent an uncomplicated hysterectomy between April 2015 and December 2017. After informed consent we ultimately included 242 cases in our analysis. The mean age of our study population was 50 years. In 194 (802 %) patients the catheter was removed immediately after surgery. Main reason for delayed removal of the catheter was resection of deep endometriosis (n = 21). The incidence of urinary retention was 4,6 % (95 % CI 2,3-8,3 %) in the immediate removal group. In these 9 cases, 5 (2,6 %) where solved after single catheterisation. The remaining 4 patients (2,0 %) had an indwelling catheter for 24 h after which the urinary retention resolved. The incidence of urinary tract infection was 9,3 % (95 % CI 5,8-14,0- %), when the catheter was removed immediately after surgery. The incidence of urinary retention and UTI were respectively 2,1% (95 % CI 0,1-9,8%) and 208 % (95 % CI 11,1-34,0 %) in the cases with delayed catheter removal (N = 48). CONCLUSION Immediate removal of the urine catheter after uncomplicated hysterectomy is safe and results in low levels of urinary retention.
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Behbehani S, Delara R, Yi J, Kunze K, Suarez-Salvador E, Wasson M. Predictors of Postoperative Urinary Retention in Outpatient Minimally Invasive Hysterectomy. J Minim Invasive Gynecol 2020; 27:681-686. [DOI: 10.1016/j.jmig.2019.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/16/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
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Chao L, Mansuria S. Postoperative Bladder Filling After Outpatient Laparoscopic Hysterectomy and Time to Discharge: A Randomized Controlled Trial. Obstet Gynecol 2020; 133:879-887. [PMID: 30969209 DOI: 10.1097/aog.0000000000003191] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine whether backfilling the bladder postoperatively will reduce time to discharge in patients undergoing outpatient laparoscopic hysterectomy. METHODS In a single-blind, randomized, controlled trial among women undergoing outpatient laparoscopic hysterectomy, patients were randomly assigned to a backfill-assisted void trial or a trial of spontaneous voiding. The primary outcome was time to discharge assessed by length of time spent in the postanesthesia care unit. Secondary outcomes included time to first spontaneous void, urinary retention rates, and postoperative complications within 8 weeks. We estimated that 152 patients (76/group) would provide greater than 80% power to identify a 30-minute difference in the primary outcome with a SD of 56 minutes and a two-sided α of 0.05. RESULTS Between June 2017 to May 2018, 202 women were screened, 162 women were randomized, and results were analyzed for 153 women. Seventy-five patients (group A) who had a backfill-assisted voiding trial and 78 patients (group B) who had a spontaneous voiding trial were included in the analysis. The mean time to discharge was 273.4 minutes for group A vs 283.2 minutes for group B, which was not found to be significant (P=.45). The mean time to first spontaneous void was 181.1 minutes in group A vs 206.0 minutes in group B. There was a statistically significant reduction of 24.9 minutes in time to first spontaneous void with patients randomized to the backfill group (P=.04). Five of 75 patients (6.7%) in group A and 10 of 78 patients (12.8%) in group B developed urinary retention postoperatively and required recatheterization before discharge, which was also not significant (P=.20). CONCLUSION Bladder filling before removing the Foley catheter is a simple procedure shown to reduce time to first spontaneous void, but not time to discharge in patients undergoing outpatient laparoscopic hysterectomy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT03126162.
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Affiliation(s)
- Lisa Chao
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania
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22
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Rimmer MP, Henderson I, Keay SD, Khan KS, Al Wattar BH. Early versus delayed urinary catheter removal after hysterectomy: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 247:55-60. [PMID: 32065990 DOI: 10.1016/j.ejogrb.2020.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES In bladder drainage, an essential part of post-hysterectomy care, the optimal timing for removing the urinary catheter is unclear. Our objective was to evaluate the risks and benefits of early (<6 h) vs delayed (>6 h) catheter removal post-hysterectomy. STUDY DESIGN A systematic review searching MEDLINE, EMBASE and Cochrane CENTRAL from inception till May 2019 for randomised trials of women undergoing hysterectomy. We reported on urinary retention, positive urine culture, urinary tract infection (UTI) (defined by symptoms and/or antibiotic use), post-operative pyrexia, time to ambulation, and length of hospital stay. We assessed risk of bias in included trials and used a random-effect model to generate risk ratios (RR) for dichotomous outcomes and weighted mean differences (WMD) for continuous outcomes, with 95 % confidence intervals (CI). RESULTS Of 1020 potentially relevant citations, we included 10 randomised trials (1120 women). Four trials had low risk of bias for randomisation and allocation concealment while five had low risk for outcome assessment and selective reporting. Compared to delayed removal, women in the early catheter removal group had a higher risk of urinary retention and needing re-catheterisation (10 RCTs, RR 3.61, 95 %CI 1.21-9.21, I2 = 56 %). There was some reduction in the risk of post-operative UTI (6 RCTs, RR 0.42, 95 %CI 0.18 to 0.96, I2 = 0 %), but we did not find a significant difference in post-operative pyrexia (6 RCTs, RR 0.73, 95 %CI 0.43-1.24, I2 = 18 %) or positive urine cultures (6 RCTs, RR of 0.56, 95 %CI 0.27-1.12, I2 = 55 %). There was no significant difference in the average time to ambulation (3RCTs, WMD -4.6, 95 %CI -9.16 to -0.18, I2 = 98 %) and length of hospital stay (3RCTs, WMD -1.05, 95 %CI -2.42 to 0.31, I2 = 98 %). Our meta-regression on the provision of prophylactic antibiotics did not show a significant effect on the reported outcomes. Our analysis was limited by our inability to adjust for potential effect modifiers such as the surgical route. CONCLUSIONS Early removal of the urinary catheter <6 h post-hysterectomy seems to increase the risk of urinary retention and needing re-catheterisation, but may reduce post-operative UTI.
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Affiliation(s)
- Michael P Rimmer
- MRC Centre for Reproductive Health, Queens Medical Research Institute, Edinburgh BioQuarter, University of Edinburgh, UK
| | - Ian Henderson
- Warwick Medical School, Warwick University, Coventry, UK; University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, UK
| | - Stephen D Keay
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, UK
| | - Khalid S Khan
- Department of Preventive Medicine and Public Health, University of Granada, 18071 Granada, Spain
| | - Bassel H Al Wattar
- Warwick Medical School, Warwick University, Coventry, UK; University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, UK.
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Nevo A, Haidar AM, Navaratnam A, Humphreys M. Urinary Retention Following Non-urologic Surgery. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00518-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Moawad G, Tyan P, Marfori C, Abi Khalil E, Park D. Effect of postoperative partial bladder filling after minimally invasive hysterectomy on postanesthesia care unit discharge and cost: a single-blinded, randomized controlled trial. Am J Obstet Gynecol 2019; 220:367.e1-367.e7. [PMID: 30639089 DOI: 10.1016/j.ajog.2018.12.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hysterectomy is one of the most common surgical procedures performed each year with substantial related health care costs. This trial studied the effect of postoperative bladder backfilling to submicturition level in the operating room and its effect on early postoperative patient care and related cost. OBJECTIVE The objective of the study was to compare the effect of bladder backfilling on early postoperative patient care and related cost. STUDY DESIGN This was a randomized, single-blinded, controlled trial conducted between April 2016 and February 2017 at a single urban university hospital providing tertiary care for minimally invasive gynecologic surgery. Ninety-one patients undergoing straight-stick laparoscopic and robot-assisted hysterectomy by minimally invasive gynecologic surgeons for benign indications were recruited. The bladder was partially backfilled with 150 mL of normal saline postoperatively in the intervention group and drained in the control group, as per standard of care. Main outcomes studied were time needed to void, time spent in the postanesthesia care unit, and postanesthesia care unit cost after minimally invasive hysterectomy. Our secondary outcomes were postoperative complications. RESULTS Forty-six patients (50.5%) were randomized to the intervention group, and 45 patients (49.5%) to the control group. Baseline comparative analysis of demographics and preoperative patient-specific variables, surgical history, intraoperative characteristics, and administered medications found the 2 groups to be largely homogenous. After regression analyses for adjustment, we found a significant reduction in the time needed to void, time spent in the postanesthesia care unit, and postanesthesia care unit-associated cost in the intervention group. Patients voided 64.9 minutes earlier than the control group (P = .015) ans spent 64 fewer minutes in the postanesthesia care unit (P = .006), resulting in $401.5 (USD) saving per patient (P = .006). None of the patients encountered any postoperative complications. CONCLUSION Based on the findings of this randomized clinical trial, postoperative bladder backfilling to submicturition level shortens the time needed for patients to void in the postanesthesia care unit, resulting in shorter postanesthesia care unit stay and resultant cost savings. Conservatively projecting our findings on minimally invasive hysterectomy procedure is estimated to result in $69 million to $139 million (USD) per year in savings. Initiating similar investigations in other ambulatory surgical fields will likely result in a more substantial impact.
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Affiliation(s)
- Gaby Moawad
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, George Washington University Hospital, Washington, DC.
| | - Paul Tyan
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Cherie Marfori
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, George Washington University Hospital, Washington, DC
| | - Elias Abi Khalil
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, George Washington University Hospital, Washington, DC
| | - Daniel Park
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC
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Sandberg EM, Twijnstra A, van Meir CA, Kok HS, van Geloven N, Gludovacz K, Kolkman W, Nagel H, Haans L, Kapiteijn K, Jansen FW. Immediate versus delayed removal of urinary catheter after laparoscopic hysterectomy: a randomised controlled trial. BJOG 2019; 126:804-813. [PMID: 30548529 PMCID: PMC6593458 DOI: 10.1111/1471-0528.15580] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2018] [Indexed: 11/29/2022]
Abstract
Objective To evaluate if immediate catheter removal (ICR) after laparoscopic hysterectomy is associated with similar retention outcomes compared with delayed removal (DCR). Study design Non‐inferiority randomised controlled trial. Population Women undergoing laparoscopic hysterectomy in six hospitals in the Netherlands. Methods Women were randomised to ICR or DCR (between 18 and 24 hours after surgery). Primary outcome The inability to void within 6 hours after catheter removal. Results One hundred and fifty‐five women were randomised to ICR (n = 74) and DCR (n = 81). The intention‐to‐treat and per‐protocol analysis could not demonstrate the non‐inferiority of ICR: ten women with ICR could not urinate spontaneously within 6 hours compared with none in the delayed group (risk difference 13.5%, 5.6–24.8, P = 0.88). However, seven of these women could void spontaneously within 9 hours without additional intervention. Regarding the secondary outcomes, eight women from the delayed group requested earlier catheter removal because of complaints (9.9%). Three women with ICR (4.1%) had a urinary tract infection postoperatively versus eight with DCR (9.9%, risk difference −5.8%, −15.1 to 3.5, P = 0.215). Women with ICR mobilised significantly earlier (5.7 hours, 0.8–23.3 versus 21.0 hours, 1.4–29.9; P ≤ 0.001). Conclusion The non‐inferiority of ICR could not be demonstrated in terms of urinary retention 6 hours after procedure. However, 70% of the women with voiding difficulties could void spontaneously within 9 hours after laparoscopic hysterectomy. It is therefore questionable if all observed urinary retention cases were clinically relevant. As a result, the clinical advantages of ICR may still outweigh the risk of bladder retention and it should therefore be considered after uncomplicated laparoscopic hysterectomy. Tweetable abstract The advantages of immediate catheter removal after laparoscopic hysterectomy seem to outweigh the risk of bladder retention. The advantages of immediate catheter removal after laparoscopic hysterectomy seem to outweigh the risk of bladder retention.
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Affiliation(s)
- E M Sandberg
- Department of Gynaecology, Leids Universitair Medisch Centrum, Leiden, the Netherlands
| | - Arh Twijnstra
- Department of Gynaecology, Leids Universitair Medisch Centrum, Leiden, the Netherlands
| | - C A van Meir
- Department of Gynaecology, Groene Hart Ziekenhuis, Gouda, the Netherlands
| | - H S Kok
- Departement of Gynaecology, Alrijne Ziekenhuis, Leiden/Leiderdorp, the Netherlands
| | - N van Geloven
- Department of Biomedical Data Sciences, Section Medical Statistics, Leids Universitair Medisch Centrum, Leiden, the Netherlands
| | - K Gludovacz
- Departement of Gynaecology, Alrijne Ziekenhuis, Leiden/Leiderdorp, the Netherlands
| | - W Kolkman
- Department of Gynaecology, HagaZiekenhuis, The Hague, the Netherlands
| | - Htc Nagel
- Department of Gynaecology, Haaglanden Medisch Centrum, The Hague, the Netherlands
| | - Lcf Haans
- Department of Gynaecology, Haaglanden Medisch Centrum, The Hague, the Netherlands
| | - K Kapiteijn
- Department of Gynaecology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - F W Jansen
- Department of Gynaecology, Leids Universitair Medisch Centrum, Leiden, the Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
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Into the void: a review of postoperative urinary retention after minimally invasive gynecologic surgery. Curr Opin Obstet Gynecol 2018; 30:260-266. [DOI: 10.1097/gco.0000000000000465] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sandberg EM, Leinweber FS, Herbschleb PJ, Berends-van der Meer DMA, Jansen FW. Urinary catheterisation management after laparoscopic hysterectomy: a national overview and a nurse preference survey. J OBSTET GYNAECOL 2018; 38:1115-1120. [PMID: 29884072 DOI: 10.1080/01443615.2018.1447914] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The aim of this study was to evaluate the catheterisation regimes after a laparoscopic hysterectomy (LH) in Dutch hospitals and to assess the nurses' opinion on this topic. This was particularly relevant as no consensus exists on the best moment to remove a urinary catheter after an LH. All 89 Dutch hospitals were successfully contacted and provided information on their catheterisation regime after LH: 69 (77.5%) hospitals reported removing the catheter the next morning after the LH, while nine hospitals (10.1%) removed it directly at the end of the procedure. The other 11 hospitals had different policies (four hours, up to two days). Additionally, all nurses working in the gynaecology departments of the hospitals affiliated to Leiden University were asked to fill in a self-developed questionnaire. Of the 111 nurses who completed the questionnaire (response rate 81%), 90% was convinced that a direct removal was feasible and 78% would recommend it to a family member or friend. Impact Statement What is already known on this subject? Although an indwelling catheter is routinely placed during a hysterectomy, it is unclear what the best moment is to remove it after an LH specifically. To fully benefit from the advantages associated with this minimally invasive approach, postoperative catheter management, should be, amongst others, optimal and LH-specific. A few studies have demonstrated that the direct removal of urinary catheter after an uncomplicated LH is feasible, but the evidence is limited. What the results of this study add? While waiting for the results of the randomised trials, this present study provides insight into the nationwide catheterisation management after an LH. Despite the lack of consensus on the topic, catheterisation management was quite uniform in the Netherlands: most Dutch hospitals removed the urinary catheter one day after an LH. Yet, this was not in line with the opinion of the surveyed nurses, as the majority would recommend a direct removal. This is interesting as nurses are closely involved in the patients' postoperative care. What are the implications of these findings for clinical practice and/or further research? Although randomised trials are necessary to determine an optimal catheterisation management, the findings of this present study are valuable if a new urinary catheter regime has to be implemented.
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Affiliation(s)
- Evelien M Sandberg
- a Department of Gynaecology , Leiden University Medical Centre , Leiden , The Netherlands
| | - Fleur S Leinweber
- a Department of Gynaecology , Leiden University Medical Centre , Leiden , The Netherlands
| | - Petra J Herbschleb
- a Department of Gynaecology , Leiden University Medical Centre , Leiden , The Netherlands
| | | | - Frank Willem Jansen
- a Department of Gynaecology , Leiden University Medical Centre , Leiden , The Netherlands.,b Department of Biomechanical Engineering , Delft University of Technology , Delft , The Netherlands
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Ajao MO, Kohli N. CystoSure™: A Unique Catheter-Based Instrument for Cystoscopy and Bladder Diagnostics in the Operating Room and Office. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0209-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sandberg EM, Twijnstra AR, Driessen SR, Jansen FW. Total Laparoscopic Hysterectomy Versus Vaginal Hysterectomy: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2017; 24:206-217.e22. [DOI: 10.1016/j.jmig.2016.10.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/19/2016] [Accepted: 10/13/2016] [Indexed: 12/13/2022]
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Voiding trial outcome following pelvic floor repair without incontinence procedures. Int Urogynecol J 2016; 27:1215-20. [PMID: 26886553 DOI: 10.1007/s00192-016-2975-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Our aim was to identify predictors of postoperative voiding trial failure among patients who had a pelvic floor repair without a concurrent incontinence procedure in order to identify low-risk patients in whom postoperative voiding trials may be modified. METHODS We conducted a retrospective cohort study of women who underwent pelvic floor repair without concurrent incontinence procedures at two institutions from 1 November 2011 through 13 October 2013 after abstracting demographic and clinical data from medical records. The primary outcome was postoperative retrograde voiding trial failure. We used modified Poisson regression to calculate the risk ratio (RR) and 95 % confidence interval (CI). RESULTS Of the 371 women who met eligibility criteria, 294 (79.2 %) had complete data on the variables of interest. Forty nine (16.7 %) failed the trial, and those women were less likely to be white (p = 0.04), more likely to have had an anterior colporrhaphy (p = 0.001), and more likely to have had a preoperative postvoid residual (PVR) ≥150 ml (p = 0.001). After adjusting for race, women were more likely to fail their voiding trial if they had a preoperative PVR of ≥150 ml (RR: 1.9; 95 % CI: 1.1-3.2); institution also was associated with voiding trial failure (RR: 3.0; 95 % CI: 1.6-5.4). CONCLUSIONS Among our cohort, postoperative voiding trial failure was associated with a PVR of ≥150 ml and institution at which the surgery was performed.
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Urinary Retention After Hysterectomy and Postoperative Analgesic Use. Female Pelvic Med Reconstr Surg 2015; 21:257-62. [DOI: 10.1097/spv.0000000000000151] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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A systematic review and meta-analysis comparing immediate and delayed catheter removal following uncomplicated hysterectomy. Int Urogynecol J 2014; 26:665-74. [DOI: 10.1007/s00192-014-2561-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/18/2014] [Indexed: 12/11/2022]
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Manonai J, Wattanayingcharoenchai R. Surgical treatment for pelvic organ prolapse in elderly women. J OBSTET GYNAECOL 2014; 35:82-4. [DOI: 10.3109/01443615.2014.936840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nesbitt-Hawes EM, Zhang CS, Won HR, Law K, Abbott JA. Urinary retention following laparoscopic gynaecological surgery with or without 4% icodextrin anti-adhesion solution. Aust N Z J Obstet Gynaecol 2013; 53:305-9. [PMID: 23731096 DOI: 10.1111/ajo.12073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 02/06/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Urinary retention is a recognised complication of laparoscopic surgery. Previous work showed an association with 4% icodextrin solution and urinary retention. AIMS To determine the incidence of urinary retention following laparoscopic gynaecological surgery with or without the use of 4% icodextrin. METHODS A prospective observational study of 147 women undergoing laparoscopic gynaecological surgery for benign pathology. Women had their planned laparoscopic procedure and either received icodextrin solution or nothing as determined by their treating surgeon at the time of the operation. RESULTS From May 2011 to February 2012, 147 women were approached to participate in the study; of whom, 124 women were included: 62 received icodextrin and 62 did not. The women in the non-icodextrin group were significantly older (P = 0.007) and had a higher BMI (P = 0.03) than those in the icodextrin group. Following surgery, 27/124 (21.8%) women had post-operative urinary retention. Icodextrin was associated with significantly more urinary retention (P = 0.017), but did not extend hospital admission significantly (P = 0.14). The administration of icodextrin was associated with resection of moderate- or severe-stage endometriosis involving multiple surgical sites, whereas women in the non-icodextrin group were more likely to be having a hysterectomy. CONCLUSIONS In this non-randomised study, there were significantly more women with post-operative urinary retention when icodextrin was used; however, this did not contribute to an extended hospital admission. While there may be confounding factors, women receiving icodextrin should be warned of the possibility of urinary retention post-operatively, but that this is unlikely to affect their stay in hospital.
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Evaluation and Management of Urinary Retention Following Colorectal and Gynecologic Oncologic Surgery. CURRENT BLADDER DYSFUNCTION REPORTS 2012. [DOI: 10.1007/s11884-012-0155-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Suprapubic compared with transurethral bladder catheterization for gynecologic surgery: a systematic review and meta-analysis. Obstet Gynecol 2012; 120:678-87. [PMID: 22914481 DOI: 10.1097/aog.0b013e3182657f0d] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Suprapubic catheterization is commonly used for postoperative bladder drainage after gynecologic procedures. However, recent studies have suggested an increased rate of complications compared with urethral catheterization. We undertook a systematic review and meta-analysis of randomized controlled trials comparing suprapubic catheterization and urethral catheterization in gynecologic populations. DATA SOURCES PubMed, EMBASE, CINAHL, Google Scholar, and trial registries were searched from 1966 to March 2012 for eligible randomized controlled trials comparing postoperative suprapubic catheterization and urethral catheterization in gynecologic patients. We used these search terms: "catheter," "supra(-)pubic catheter," "urinary catheter," "gyn(a)ecological," "catheterization techniques gyn(a)ecological surgery," "transurethral catheter," and "bladder drainage." No language restrictions were applied. METHODS AND STUDY SELECTION: The primary outcome was urinary tract infection. Secondary outcomes were the need for recatheterization, duration of catheterization, catheter-related complications, and duration of hospital stay. Pooled effect size estimates were calculated using the random effects model from DerSimonian and Laird. TABULATION, INTEGRATION, AND RESULTS In total, 12 eligible randomized controlled trials were included in the analysis (N=1,300 patients). Suprapubic catheterization was associated with a significant reduction in postoperative urinary tract infections (20% compared with 31%, pooled odds ratio [OR] 0.31, 95% confidence interval [CI] 0.185-0.512, P<.01) but an increased risk of complications (29% compared with 11%, pooled OR 4.14, 95% CI 1.327-12.9, P=.01). Complications were mostly related to catheter tube malfunction with no visceral injuries reported. No differences in the rate of recatheterization or hospital stay were demonstrated. Robust patient satisfaction and cost-effectiveness data are lacking. CONCLUSION Based on the best available evidence, no route for bladder drainage in gynecologic patients is clearly superior. The reduced rate of infective morbidity with suprapubic catheterization is offset by a higher rate of catheter-related complications and crucially does not translate into reduced hospital stay. As yet, there are insufficient data to determine which route is most appropriate for catheterization; therefore, cost and patient-specific factors should be paramount in the decision. Minimally invasive surgery may alter the requirement for prolonged postoperative catheterization.
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Risk Factors for Postoperative Urinary Retention After Laparoscopic and Robotic Hysterectomy for Benign Indications. Obstet Gynecol 2012; 120:581-6. [DOI: 10.1097/aog.0b013e3182638c3a] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bladder Dysfunction after Gynecologic Laparoscopic Surgery for Benign Disease. J Minim Invasive Gynecol 2012; 19:76-80. [DOI: 10.1016/j.jmig.2011.09.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/21/2011] [Accepted: 09/27/2011] [Indexed: 11/15/2022]
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Surgical treatment for pelvic floor disorders in women 75 years or older: a single-center experience. Menopause 2011; 18:314-8. [PMID: 20861753 DOI: 10.1097/gme.0b013e3181f2e629] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Older patients are usually regarded as suboptimal candidates for surgical operations, particularly in cases of reparative, non-life-saving procedures. The aim of this study was to analyze the feasibility and safety of surgical treatment for pelvic floor dysfunction in advanced-age women. METHODS A single-center descriptive study was performed through a retrospective medical records review. Women 75 years or older who underwent a surgical operation for urogynecological dysfunction (pelvic organ prolapse, urinary incontinence, or both) between January 2000 and December 2009 were considered. RESULTS Overall, 138 women were included. Median age was 77 years (range, 75-95 y). Women underwent different types of surgical correction. The following procedures (alone or in combination) were performed: 102 (73.9%) vaginal hysterectomies, 106 (76.8%) anterior repairs, 36 (26%) posterior repairs, 9 (6.5%) colpocleisis, 4 vaginal vault ileococcygeus suspensions (2.9%), and 22 (15.9%) tension-free vaginal tape procedures. One (0.7%) intraoperative and five (3.6%) postoperative complications occurred. Urinary retention rate after surgical operation was 5.8%. Only one (0.7%) woman was discharged with a Foley catheter because of voiding difficulty. Clinical follow-up showed 87.6% anatomical success in women with genital prolapse and a subjective success rate of 86.4% in women undergoing anti-incontinence procedures. CONCLUSIONS Our study shows that reconstructive surgical operation is a viable treatment option for pelvic floor dysfunction in older patients.
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Bózsa S, Pótó L, Bódis J, Halvax L, Koppán M, Arany A, Csermely T, Vizer MG. Assessment of postoperative postvoid residual bladder volume using three-dimensional ultrasound volumetry. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:522-529. [PMID: 21376454 DOI: 10.1016/j.ultrasmedbio.2011.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 12/22/2010] [Accepted: 01/07/2011] [Indexed: 05/30/2023]
Abstract
The aim of our prospective study was to assess the concordance between postvoid residual volumes (PVR) of the urinary bladder obtained by two different three-dimensional (3-D) ultrasound (US) volumetric methods (VOCAL and XI VOCAL) and with measurement by the catheter in postoperative patients who have undergone radical hysterectomy. The 3-D sonographic volume-determination of PVR with both methods correlated significantly with the actual amount of PVR by the catheter. The accuracy of both 3-D US volumetric methods was significantly higher under 300 mL of PVR. Bland-Altman plots were generated to examine limits of agreement. Both noninvasive 3-D sonographic methods are appropriate for the correct volume-determination of PVR following radical hysterectomy. Thus, we may avoid routine, albeit often unnecessary, catheterization to measure postoperative residual bladder volumes and subsequently the incidence of lower urinary tract infection may be reduced and better postoperative comfort for patients may be permitted.
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Affiliation(s)
- Szabolcs Bózsa
- Department of Obstetrics and Gynecology, University of Pécs, Faculty of Medicine, Pécs, Hungary.
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Ghezzi F, Uccella S, Cromi A, Siesto G, Serati M, Bogani G, Bolis P. Postoperative pain after laparoscopic and vaginal hysterectomy for benign gynecologic disease: a randomized trial. Am J Obstet Gynecol 2010; 203:118.e1-8. [PMID: 20522410 DOI: 10.1016/j.ajog.2010.04.026] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 03/09/2010] [Accepted: 04/14/2010] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare postoperative pain after laparoscopic and vaginal hysterectomy for benign disease. STUDY DESIGN A prospective randomized trial was designed to compare laparoscopic hysterectomy and vaginal hysterectomy in patients with uterine volume <or=14 weeks of gestation. Postoperative pain was measured using the visual analog scale (VAS) at 1, 3, 8, and 24 hours postoperatively. Intra- and postoperative outcomes were carefully recorded, including the need for postoperative rescue doses of analgesia. RESULTS A total of 82 patients were enrolled. Patients who underwent vaginal hysterectomy complained of higher postoperative pain at each VAS evaluation (VAS-1 hour, P < .0001; VAS-3 hour, P < .0001; VAS-8 hour, P < .0001; VAS-24 hour, P = .0003) with a higher need for rescue analgesia (P < .0001) and a longer hospitalization (P = .001). The other perioperative characteristics were comparable between the 2 groups. CONCLUSION Laparoscopic hysterectomy provides an advantage over vaginal hysterectomy in terms of postoperative pain, need for rescue analgesia and hospital stay, with similar perioperative outcomes.
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Affiliation(s)
- Fabio Ghezzi
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy.
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Liang CC, Lee CL, Chang TC, Chang YL, Wang CJ, Soong YK. Postoperative urinary outcomes in catheterized and non-catheterized patients undergoing laparoscopic-assisted vaginal hysterectomy—a randomized controlled trial. Int Urogynecol J 2008; 20:295-300. [DOI: 10.1007/s00192-008-0769-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 10/28/2008] [Indexed: 12/14/2022]
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