Two techniques for assessing postoperative voiding function, a randomized trial.

Area of Science:

• Urology
• Gynecology
• Surgical Outcomes

Background:

• Post-operative voiding dysfunction is a frequent complication following sling placement surgery.
• Voiding trials (VT) are standard for assessing bladder function before patient discharge.

Purpose of the Study:

• To evaluate if initiating a retrograde voiding trial (VT) in the operating room (OR-fill) decreases total post-anesthesia care unit (PACU) time compared to initiating it in the PACU (PACU-fill).

Main Methods:

• A parallel, non-blinded randomized trial was conducted with women undergoing outpatient sling surgery.
• The OR-fill group had fluid left in the bladder post-cystoscopy; the PACU-fill group had fluid initiated in the PACU.
• A post-void residual (PVR) ≤100 mL defined a successful VT; total PACU time was the primary outcome.

Main Results:

• Time from PACU arrival to VT initiation was shorter in the OR-fill group (41.5 min vs 69.0 min, p=0.03).
• However, total PACU time was similar between groups (125.0 min vs 131.5 min, p=0.76).
• Bladder volume before VT was greater in the OR-fill group (557.3 mL vs 433.0 mL, p=0.01), with no significant difference in VT pass rates.

Conclusions:

• Operating room-initiated retrograde voiding trials do not reduce total PACU time compared to PACU-initiated trials.
• No instances of bladder overdistension occurred in either group.
• Transient postoperative voiding dysfunction is a common occurrence after sling procedures.