Two techniques for assessing postoperative voiding function, a randomized trial

Post-operative voiding dysfunction is common after sling placement and is assessed with a voiding trial (VT) before discharge. We hypothesized that an operating room (OR) initiated retrograde VT (OR-fill) would decrease time to discharge compared with a post-anesthesia care unit (PACU) initiated retrograde VT (PACU-fill).

This was a parallel non-blinded randomized trial, of women undergoing outpatient sling surgery at a university hospital. In the OR-fill group, fill was initiated after sling placement during cystoscopy by leaving fluid in the bladder. In the PACU-fill group, fill was initiated in the PACU. Pre-VT volumes were recorded and a PVR ≤ 100 mL defined a passed VT. The primary outcome was total PACU time, defined as arrival in PACU until discharge home.

Thirty women were assigned to the OR-fill group and 29 to the PACU-fill group. Time from PACU arrival to VT was shorter in the OR-fill group (41.5 [31.0, 69.3] min vs 69.0 [44.0, 107.0] min, p = 0.03), but total PACU time in the groups was similar (125.0 [90.5, 180.5] min vs 131.5 [93.5, 178.0] min, p = 0.76). Bladder volume before VT was greater in the OR-fill group (557.3 ± 187.3 mL vs 433.0 ± 171.2 mL, p = 0.01). VT pass rates of the two groups were not significantly different (OR-fill 16.7% vs PACU-fill 24.1%, p = 0.48).

OR-fill VT did not decrease total PACU time compared with PACU-fill VT. No overdistension was seen in either group; transient postoperative voiding dysfunction was common.