16 Postoperative clinical assessment of voiding function using force of stream in women with acute postoperative urinary retention following pelvic reconstructive surgery

Abstract

The primary objective of this study was to evaluate and compare in-office retrograde fill voiding trial pass rates to the subjective scores on the urinary Force of Stream visual analog scale in the clinical setting in women with acute postoperative urinary retention managed with transurethral catheterization following pelvic reconstructive surgery. This was a prospective cohort study conducted across two fellowship clinical training sites between October 2017 and April 2019. Women with acute postoperative urinary retention managed with transurethral catheterization following pelvic reconstructive surgery who had been consented and randomized to the parent study were included. Women presented for an in-office retrograde fill voiding trial 1-7 days postoperatively after failure of voiding trial prior to hospital discharge. Immediately following a timed voiding attempt, each participant completed a urinary Force of Stream visual analog scale (Figure 1), with a score of “100” equivalent to voiding function prior to surgery. Following subjective assessment with the Force of Stream visual analog scale, the voided amount was measured and post-void residual was obtained by a portable bladder scanner. The primary outcome was urinary Force of Stream score. Secondary outcomes included postoperative urinary tract infections. Descriptive statistics were utilized. Data was collected on 156 women during the study period. Study participants were divided into two groups: scores >100 (n = 81) and scores ≤100 (n = 75). No demographic differences were observed. The median duration of catheterization was 3 days in each group (P = 0.11). There were no differences in types of surgical procedure between groups, except for mid urethral slings (3 vs 10, P = 0.03). There were significant differences in the median scores between the >100 score group and ≤100 score group (120 vs 100, P = < 0.001). Women in the >100 score group had significantly lower post-void residual volumes compared to women in the ≤100 score group (0 mL vs 15 mL, P = 0.003). There was no difference in time to void between groups (7.4 ± 8.4 versus 9.9 ± 10.1 minutes, P = 0.10). No participants returned with postoperative urinary retention. There was no difference in urinary tract infections between groups postoperatively at 30 days (14.8% versus 22.7%, P = 0.21). Subjective assessment of the urinary Force of Stream, especially with scores >100, correlated well with objective voiding trials, and demonstrated low post-void residuals. Urinary Force of Stream may be considered as an alternative assessment in the clinical setting in women with acute postoperative voiding dysfunction.