Implementation of a standardized voiding protocol after minimally invasive surgery: A quality improvement initiative

Abstract

To assess the effects of the implementation of a standardized voiding protocol in patients undergoing minimally invasive hysterectomy at a single cancer center in terms of the urinary tract infection (UTI) rate, time to first void, and overnight stays secondary to urinary retention. We enrolled 102 consecutive patients undergoing minimally invasive hysterectomy at a single cancer center during a 12-month period. A pre-intervention cohort of 100 consecutive patients was identified for comparison. A multidisciplinary team developed and implemented a standardized voiding protocol using quality improvement methodology. We compared the demographics, time to first void, rate of urinary retention, and UTI rates between the pre- and post-intervention cohorts. Our intervention led to a significant reduction in the time to first void (289 min vs. 566 min; P< 0.001), rate of urinary retention (2% vs. 10%; P= 0.015), and postoperative UTI (4% vs. 8%; P= 0.249). There was a similar rate of patients going home with a Foley catheter (9% vs. 11%; P= 0.850). Implementation of a standardized voiding protocol was associated with a reduction in rate of UTI, time to first void, and overnight stays secondary to urinary retention.