Is a Postvoid Residual Necessary? A Randomized Trial of Two Postoperative Voiding Protocols.
Adult
Aged
Female
Follow-Up Studies
Humans
Male
Middle Aged
Pelvic Organ Prolapse
/ surgery
Postoperative Complications
/ diagnosis
Prospective Studies
Suburethral Slings
Urinary Catheterization
/ statistics & numerical data
Urinary Incontinence, Stress
/ surgery
Urinary Retention
/ diagnosis
Urologic Surgical Procedures
Journal
Female pelvic medicine & reconstructive surgery
ISSN: 2154-4212
Titre abrégé: Female Pelvic Med Reconstr Surg
Pays: United States
ID NLM: 101528690
Informations de publication
Date de publication:
01 02 2021
01 02 2021
Historique:
pubmed:
4
6
2019
medline:
15
12
2021
entrez:
4
6
2019
Statut:
ppublish
Résumé
This study aimed to compare a backfill-assisted voiding trial (VT) with and without a postvoid residual (PVR) after pelvic reconstructive surgery. This was a nonblinded randomized controlled trial of women undergoing pelvic organ prolapse and/or stress incontinence surgery. Participants were randomized immediately after surgery to either a PVR VT or a PVR-free VT. Our primary outcome was the rate of VT failure at discharge. Secondary outcomes included days of catheterization, urinary tract infection (UTI), and prolonged voiding dysfunction. With a power of 80% and an α of 0.05, we needed 126 participants to detect a 25% difference in VT failure (60% in PVR VT vs 35% in PVR-free VT). Participants were enrolled from March 2017 to October 2017. Of the 150 participants, mean age was 59 years, and 33% underwent vaginal hysterectomy, 48% underwent anterior repair, and 75% underwent midurethral sling. Seventy-five (50%) were randomized to PVR VT and 75 (50%) to PVR-free VT, with no differences in baseline demographic or intraoperative characteristics between the 2 groups. Our primary outcome, VT failure, was not significantly different (53% PVR VT vs 53% PVR-free VT, P = 1.0). There were no significant differences in days of postoperative catheterization (1 [0, 4] in PVR VT vs 1 [0, 4] in PVR-free VT, P = 0.90), UTI (20% PVR VT vs 20% PVR-free VT, P = 1.0), or postoperative voiding dysfunction (4% PVR VT vs 5% PVR-free VT, P = 1.0). When performing a backfill-assisted VT, checking a PVR does not affect VT failure, postoperative duration of catheterization, UTI, or voiding dysfunction.
Identifiants
pubmed: 31157716
pii: 01436319-202102000-00014
doi: 10.1097/SPV.0000000000000743
doi:
Banques de données
ClinicalTrials.gov
['NCT03009968']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e256-e260Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR002489
Pays : United States
Informations de copyright
Copyright © 2019 American Urogynecologic Society. All rights reserved.
Déclaration de conflit d'intérêts
The authors have declared they have no conflicts of interest.
Références
Geller EJ, Hankins KJ, Parnell BA, et al. Diagnostic accuracy of retrograde and spontaneous voiding trials for postoperative voiding dysfunction: a randomized controlled trial. Obstet Gynecol 2011;118(3):637–642.
Schiotz HA, Tanbo TG. Postoperative voiding, bacteriuria and urinary tract infection with Foley catheterization after gynecological surgery. Acta Obstet Gynecol Scand 2006;85(4):476–481.
Foster RT Sr., Borawski KM, South MM, et al. A randomized, controlled trial evaluating 2 techniques of postoperative bladder testing after transvaginal surgery. Am J Obstet Gynecol 2007;197(6):627 e621–627 e624.
Hakvoort RA, Thijs SD, Bouwmeester FW, et al. Comparing clean intermittent catheterisation and transurethral indwelling catheterisation for incomplete voiding after vaginal prolapse surgery: a multicentre randomised trial. BJOG 2011;118(9):1055–1060.
Hakvoort RA, Burger MP, Emanuel MH, et al. A nationwide survey to measure practice variation of catheterisation management in patients undergoing vaginal prolapse surgery. Int Urogynecol J Pelvic Floor Dysfunct 2009;20(7):813–818.
Sutkin G, Alperin M, Meyn L, et al. Symptomatic urinary tract infections after surgery for prolapse and/or incontinence. Int Urogynecol J 2010;21(8):955–961.
Dieter AA, Amundsen CL, Edenfield AL, et al. Oral antibiotics to prevent postoperative urinary tract infection: a randomized controlled trial. Obstet Gynecol 2014;123(1):96–103.
Dieter AA, Amundsen CL, Visco AG, et al. Treatment for urinary tract infection after midurethral sling: a retrospective study comparing patients who receive short-term postoperative catheterization and patients who pass a void trial on the day of surgery. Female Pelvic Med Reconstr Surg 2012;18(3):175–178.
Elkadry EA, Kenton KS, FitzGerald MP, et al. Patient-selected goals: a new perspective on surgical outcome. Am J Obstet Gynecol 2003;189(6):1551–1557; discussion 1557–1558.
Pulvino JQ, Duecy EE, Buchsbaum GM, et al. Comparison of 2 techniques to predict voiding efficiency after inpatient urogynecologic surgery. J Urol 2010;184(4):1408–1412.
Ingber MS, Vasavada SP, Moore CK, et al. Force of stream after sling therapy: safety and efficacy of rapid discharge care pathway based on subjective patient report. J Urol 2011;185(3):993–997.
Tunitsky-Bitton E, Murphy A, Barber MD, et al. Assessment of voiding after sling: a randomized trial of 2 methods of postoperative catheter management after midurethral sling surgery for stress urinary incontinence in women. Am J Obstet Gynecol 2015;212(5):597 e591–597 e599.
Schulz KF, Altman DG, Moher D, et al. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Obstet Gynecol 2010;115(5):1063–1070.
Barber MD, Kleeman S, Karram MM, et al. Transobturator tape compared with tension-free vaginal tape for the treatment of stress urinary incontinence: a randomized controlled trial. Obstet Gynecol 2008;111(3):611–621.
Meekins AR, Siddiqui NY, Amundsen CL, et al. Improving postoperative efficiency: an algorithm for expedited void trials after urogynecologic surgery. South Med J 2017;110(12):785–790.
Myers EM, Matthews CA, Crane AK, et al. Two techniques for assessing postoperative voiding function, a randomized trial. Int Urogynecol J 2017;28(10):1567–1572.