Post-Operative Voiding Function after Total Laparoscopic Hysterectomy with Transvaginal Versus Transabdominal Morcellation

Abstract

<h3>Study Objective</h3> To determine the rates of post-operative urinary retention (POUR) in patients who have undergone transvaginal and transabdominal morcellation for large multifibroid and adenomyotic uteri during a total laparoscopic hysterectomy. <h3>Design</h3> Retrospective, multi-centre, cohort study. <h3>Setting</h3> Multi-centre healthcare system serving Calgary and Southern Alberta population. <h3>Patients or Participants</h3> The patients of four high-volume minimally invasive gynecologists were included in this study. Women 18 years and older who underwent a total laparoscopic hysterectomy requiring morcellation between January 2015 to April 2021 were included. Those with pre-existing urinary retention were excluded. <h3>Interventions</h3> Retrospective observational cohort study. <h3>Measurements and Main Results</h3> POUR was defined as urinary retention requiring an indwelling or in-and-out catheter post-operatively prior to discharge. No difference in POUR was found between transvaginal (29/139, 20.9%) and transabdominal (12/56, 21.4%) morcellation. There were also no differences in time to first post-operative void (5.5±4.5h vs 5.75±3.25h), length of stay (23±5h vs 22±6h), post-operative UTI (5.1% vs 3.6%) or presentation to the emergency department for POUR post-discharge (1.4% vs 1.8%) for transvaginal and transabdominal morcellation, respectively. A trend towards increased complication rate at the time of morcellation (7% vs 0%) and urinary complaints at post-operative follow-up appointments (9.4% vs 0%) were noted in the vaginal morcellation group. <h3>Conclusion</h3> With respect to route of uterine morcellation, patients who undergo transvaginal and transabdominal approaches have similar rates of POUR. It is reasonable for surgeon preference to guide the decision about route of morcellation. Larger prospective trials are needed to further assess POUR and the potential increased complication rate and post-operative urinary complaints with transvaginal morcellation.