Is a Postvoid Residual Necessary? A Randomized Trial of Two Postoperative Voiding Protocols.

Area of Science:

• Urology
• Gynecologic Surgery
• Pelvic Floor Disorders

Background:

• Pelvic reconstructive surgery for prolapse or incontinence often requires voiding trials (VT) to ensure successful bladder function post-operatively.
• Backfill-assisted VTs are common, but the necessity of measuring postvoid residual (PVR) remains debated.
• Standardizing VT protocols can improve patient outcomes and streamline recovery.

Purpose of the Study:

• To compare the efficacy of backfill-assisted voiding trials (VT) with and without postvoid residual (PVR) measurement after pelvic reconstructive surgery.
• To determine if PVR measurement influences voiding trial failure rates, catheterization duration, or the incidence of urinary tract infections (UTIs) and voiding dysfunction.

Main Methods:

• A nonblinded randomized controlled trial was conducted involving women undergoing pelvic organ prolapse and/or stress incontinence surgery.
• Participants were randomized to either a PVR-assisted VT or a PVR-free VT immediately after surgery.
• The primary outcome was VT failure at discharge, with secondary outcomes including catheterization duration, UTI, and voiding dysfunction.

Main Results:

• No significant difference was observed in VT failure rates between the PVR VT group (53%) and the PVR-free VT group (53%), P = 1.0.
• Secondary outcomes also showed no significant differences: days of catheterization (1 vs 1), UTI rates (20% vs 20%), and postoperative voiding dysfunction (4% vs 5%).
• Baseline demographics and intraoperative characteristics were similar between the two groups.

Conclusions:

• Measuring postvoid residual (PVR) during a backfill-assisted voiding trial (VT) does not significantly affect outcomes after pelvic reconstructive surgery.
• These findings suggest that PVR measurement can be omitted in backfill-assisted VTs without compromising patient safety or recovery.
• Simplifying the voiding trial protocol by omitting PVR measurement may streamline postoperative care for patients undergoing these procedures.