Retrograde Bladder Filling after Laparoscopic Gynecologic Surgery and Hospital Discharge: A Randomized Controlled Trial

Abstract

Study Objective To determine whether retrograde bladder filling after outpatient gynecologic surgery (excluding hysterectomy and pelvic reconstructive surgeries) expedites time to first void and discharge from hospital. Design Double-blind randomized controlled trial. Setting Downtown academic day-surgery hospital. Patients or Participants Women undergoing elective outpatient gynecologic laparoscopy (excluding hysterectomy/pelvic reconstructive surgery) able to provide informed consent. Interventions The intervention group underwent retrograde bladder filling in the operating room upon completion of surgery with 200mL of normal saline (NS) prior to catheter removal and extubation. In the control group, the catheter was removed prior to extubation and transfer to post-anesthesia care unit (PACU) without retrograde bladder filling. Measurements and Main Results Time and volume of first void as well as time to discharge from PACU were recorded for all patients. Patients were contacted one week post-operatively to determine whether any unexpected hospital or clinic visits occurred, and if they experienced any post-operative complications such as urinary tract infection (UTI). A total of 42 patients were enrolled in this study, with 21 patients in each arm. There were no significant differences in baseline characteristics between the two groups. Time to first void was significantly reduced in patients randomized to bladder retrofill compared to controls (median difference of 70 min, p=0.005) and were discharged on average 70.7 min sooner than unfilled controls (p=0.003). There was no difference in postoperative patient satisfaction, UTI rate, or unanticipated medical visits. Conclusion Retrograde filling the bladder after outpatient laparoscopic gynecologic surgery is a safe and effective method that significantly expedites first void after surgery and reduces length of PACU stay.