Active Versus Passive Discharge Voiding Protocols and Urinary Retention Rates after Same-Day Minimally Invasive Hysterectomy

Abstract

Study Objective The primary objective was to determine proportion of patients discharged with a urinary catheter after undergoing a same-day minimally invasive hysterectomy (MIH) for a benign gynecological condition according to active versus passive discharge voiding protocol. Secondary objectives included assessing post anesthesia care unit (PACU) duration and postoperative urinary retention (PUR) rate ≤2 weeks of discharge. Design Retrospective observational data-only cohort study. Setting A large integrated healthcare system serving over one-million reproductive-aged women annually. Patients or Participants Patients ≥18 years old, undergoing a same-day MIH for benign gynecological conditions without urogynecology procedures 2015-2018, were categorized into active or passive voiding trial groups. An active voiding trial was defined as a patient arriving in PACU with a catheter, retrograde filling the bladder with 300ml, then allowing for voiding ≥50% within 30 minutes. If unable to void this volume, then discharged with a catheter to be removed within 24 hours. A passive voiding trial involved filling or not filling the bladder prior to arriving in PACU without a catheter, then allowing for voiding or performing a straight catheterization in PACU if unable to void. Interventions N/A. Measurements and Main Results We found 1644 (83.2%) patients underwent passive voiding trials and 333 (16.8%) active voiding trials. Proportion of patients discharged with a catheter was lower in the passive voiding group than the active voiding group (5.4% versus 10.5%, P=0.001). Passive group had shorter mean PACU time than active group (218±86 versus 240±93 minutes, P Conclusion Within a large integrated healthcare system, passive voiding trials were associated with a smaller proportion of patients discharged with a catheter, shorter PACU duration, and lower PUR rate. This suggests that passive voiding trials can be safely utilized after a benign MIH to reduce hospital duration, optimize healthcare resources, and ultimately improve patient experience.