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Are Formal Voiding Trials Necessary After Posterior Compartment Reconstructive Surgery?

Amy L Askew1, Samantha L Margulies1, Nozomi Sakai2

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Posterior compartment surgery is linked to lower rates of urinary retention after vaginal reconstructive procedures. Patients undergoing posterior compartment surgery alone may not need routine voiding trials.

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Area of Science:

  • Urogynecology
  • Pelvic Floor Surgery
  • Postoperative Care

Background:

  • Posterior compartment surgery is a known risk factor for postoperative urinary retention.
  • Limited research exists on the specific association between posterior compartment reconstructive surgery and urinary retention.

Purpose of the Study:

  • To compare urinary retention rates in patients undergoing posterior compartment surgery exclusively versus those with apical and/or anterior compartment involvement.
  • To evaluate the impact of surgical site on postoperative urinary retention following vaginal reconstructive surgery.

Main Methods:

  • Retrospective cohort study of 362 patients undergoing vaginal reconstructive surgery without hysterectomy (January 2015 - November 2020).
  • Comparison of postoperative urinary retention rates (failed voiding trial) and catheterization duration between posterior compartment only surgery and apical/anterior compartment surgery groups.
  • Multivariable logistic regression analysis to identify factors associated with failed voiding trials.

Main Results:

  • The rate of postoperative urinary retention was significantly lower in the posterior compartment only group (9.9%) compared to the apical/anterior compartment group (41.6%) (P < 0.001).
  • Patients undergoing posterior compartment only surgery had significantly fewer days of catheterization (median 0 vs 0, P < 0.001).
  • Posterior compartment only surgery was independently associated with a successful voiding trial (OR, 6.0; 95% CI, 2.97-12.03).

Conclusions:

  • Postoperative urinary retention rates are low following posterior compartment surgery.
  • These findings suggest that formal voiding trials may not be necessary for all patients undergoing posterior compartment reconstructive surgery.