Postoperative Urinary Retention after Benign Gynecologic Surgery with a Liberal versus Strict Voiding Protocol

Area of Science:

• Gynecologic Surgery
• Urology
• Postoperative Care

Background:

• Postoperative urinary retention (POUR) is a common concern following gynecologic surgery.
• Current protocols often require patients to void before discharge, but evidence supporting this is limited.
• Evaluating the impact of different voiding protocols on POUR incidence is crucial for optimizing patient recovery.

Purpose of the Study:

• To compare the risk of POUR between liberal and strict voiding protocols after benign gynecologic surgery.
• To assess secondary outcomes including length of hospital stay (LOS) and urinary tract infection (UTI).
• To analyze outcomes specifically for patients undergoing minimally invasive surgery (MIS).

Main Methods:

• Retrospective cohort study of 652 patients undergoing hysterectomy or myomectomy.
• Comparison of outcomes between a liberal voiding protocol (no voiding requirement) and strict voiding protocols.
• Subgroup analysis for patients who underwent MIS.

Main Results:

• Overall POUR incidence was low (3.8%) and not significantly different between liberal (2.6%) and strict (4.9%) voiding protocols (p=0.14).
• UTI rates were also similar between groups (2.8% overall, 2.6% liberal vs. 2.9% strict).
• Patients undergoing MIS with a liberal protocol experienced significantly shorter LOS (9 hours vs. 36 hours, p<0.01) and fewer complications (11.2% vs. 16.9%, p=0.04).

Conclusions:

• Liberal voiding protocols do not increase the risk of POUR after major benign gynecologic surgery.
• Same-day discharge after MIS hysterectomy/myomectomy without a voiding requirement is safe and reduces LOS.
• Eliminating mandatory voiding protocols can enhance postanesthesia recovery and contribute to enhanced recovery after surgery (ERAS) protocols.