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Active versus Passive Voiding Protocols after Same-day Minimally Invasive Hysterectomy.

Allyse Ishino1, Lue-Yen Tucker2, Emily Navarrete1

  • 1Department of Obstetrics and Gynecology, Kaiser Permanente Northern California East Bay (Drs. Ishino, Navarrete, Stenquist, and Zaritsky).

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|August 1, 2021
PubMed
Summary

Passive voiding protocols significantly reduce urinary catheter use and postanesthesia care unit (PACU) time after minimally invasive hysterectomy (MIH). This approach safely decreases hospital duration and improves patient experience without increasing postoperative urinary retention (POUR).

Keywords:
HysterectomyLaparoscopyPostoperative urinary retentionUrinary catheterVoiding trial

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Area of Science:

  • Urogynecology
  • Minimally Invasive Surgery
  • Patient Outcomes

Background:

  • Urinary catheter use after gynecologic surgery can prolong hospital stays and impact patient comfort.
  • Optimizing voiding protocols is crucial for efficient recovery after minimally invasive hysterectomy (MIH).
  • Current practices vary, necessitating a comparison of active versus passive voiding strategies.

Purpose of the Study:

  • To compare the proportion of patients discharged with a urinary catheter following active versus passive voiding protocols after same-day benign MIH.
  • To evaluate the impact of these protocols on postanesthesia care unit (PACU) duration.
  • To assess the rate of postoperative urinary retention (POUR) within two weeks of discharge.

Main Methods:

  • Retrospective observational cohort study involving patients undergoing same-day benign MIH.
  • Patients were categorized into active voiding trials (catheter in situ, retrograde bladder filling) or passive voiding trials (no catheter initially, voiding encouraged).
  • Data collected included catheter discharge rates, PACU duration, and POUR rates.

Main Results:

  • A significantly lower proportion of patients were discharged with a catheter in the passive voiding group (5.4%) compared to the active group (10.5%).
  • The passive voiding group experienced shorter mean PACU durations (218 minutes) than the active group (240 minutes).
  • Postoperative urinary retention (POUR) rates were similar between the groups (1.8% passive vs. 3.0% active).

Conclusions:

  • Passive voiding trials are associated with a reduced need for urinary catheter discharge and shorter PACU stays after benign MIH.
  • This strategy appears safe, with no significant difference in POUR rates compared to active voiding trials.
  • Implementing passive voiding protocols can optimize healthcare resources and enhance the patient experience post-MIH.