22: Comparison of postoperative voiding dysfunction in two different voiding trials after tension-free vaginal tape with or without concomitant surgery

Abstract

Postoperative voiding dysfunction (POVD) commonly affects women after gynecologic surgery for urinary incontinence and/or pelvic organ prolapse. Common voiding trial (VT) methods include spontaneous fill, retrograde fill, and bladder scanning. Currently, there is no consensus on which VT method is the best to predict POVD. POVD includes postoperative urinary retention (POUR), which requires catheterization, and the associated risks such as urinary tract infection (UTI). The objective of this retrospective cohort study was to compare the rate of POUR requiring catheterization in two different VTs after tension-free vaginal tape (TVT) +/− concomitant surgery. The secondary objective was to compare the rate of UTI within 6 weeks of surgery. Two different VTs have been routinely utilized by different groups of surgeons in our Urban Academic Medical Center: Group 1 (SVT) allows patients up to 6 hours after surgery for spontaneous voiding without measurement of post void residual (PVR). Group 2 (RVT) performs a retrograde fill of the bladder with sterile water (300 cc) and expected the patient to void (200 cc) within 30 minutes of filling. A total of 256 women who underwent TVT +/− concomitant surgery (i.e., hysterectomy, salpingectomy, oophorectomy, anterior/posterior/apical repair) between January 2014 and December 2016 at three campuses were extracted for chart review. Twenty-one of them who experienced the intraoperative complications (i.e., bladder perforation) were excluded. Demographics and outcomes were compared between the groups using Student’s t-test, Wilcoxon rank-sum, Chi-square, and Fisher’s exact tests, as appropriate. Demographics are shown in Table 1. Women in the RVT group were more likely to be postmenopausal (62.4% vs. 46.2%; p < 0.02) and less likely to have had previous pelvic surgery (35.7% vs. 53.3%, p = 0.01). The overall rate of POUR was 10.6%. Women in the RVT group were more likely to experience POUR which required discharge home with a Foley catheter compared to those in SVT (15.3% vs. 1.3%, p < 0.01). Among those who went home with a Foley catheter (1 SVT and 24 RVT), 24 of them (1 SVT and 23 RVT) received RVT in-office within a week from a surgery and passed the trial (1/25 data unknown). For those who went home without a Foley catheter, there was no incidence of re-catheterization or POUR after successful void in either group. The overall UTI rate within 6 week of surgery was 6.2%. The UTI rate was higher in the RVT group but did not reach statistical significance (7.6% in RVT vs. 3.9% in SVT, p = 0.38). Concomitant surgeries did not influence the rate of POUR or UTI. In our population who underwent TVT +/− concomitant surgeries, the overall rate of POUR requiring discharge home with a Foley catheter was significantly higher in the RVT group compared to the SVT group. The UTIs within 6 weeks postoperatively was comparable in both groups. Knowing the amount of PVR may not be as important as simply being able to void, the SVT may be a safe and sufficient VT leading to less post-operative catheterizations. Randomized studies are needed to verify this finding.