Retrograde Bladder Filling after Outpatient Gynecologic Surgery: A Systematic Review and Meta-Analysis

Abstract

<h3>Study Objective</h3> To systematically review and meta-analyze randomized controlled trials (RCTs) comparing postoperative bladder retrofilling to passive filling after outpatient gynecologic surgery to evaluate effects on postoperative outcomes. <h3>Design</h3> Systematic review and meta-analysis. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> Two reviewers screened 1465 articles after searching MEDLINE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and ClinicalTrials.gov from 1947 to August 2020. We included RCTs comparing postoperative bladder retrofilling to passive filling in patients who underwent outpatient gynecologic surgery by any approach. The primary outcome was time to first void. Secondary outcomes included time to discharge, postoperative urinary retention, urinary tract infection, and patient satisfaction. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> We included eight studies with 1173 patients. Bladder retrofilling in the operating room resulted in a significant decrease in time to first void (mean difference (MD) –33.5 minutes; 95% confidence interval (CI): –49.1 to –17.9, 4 studies, 403 patients) and time to discharge (MD –32.0 minutes; 95% CI: –51.5 to –12.6, 8 studies, 1164 patients). Bladder retrofilling did not shorten time to discharge when performed in the post-anesthetic care unit (MD –14.8 min; 95% CI: –62.6 to 32.9, 3 studies, 258 patients) or after laparoscopic hysterectomy (MD –26.0 min; 95% CI: –56.5 to 4.5, 5 studies, 657 patients). There were no differences in patient satisfaction, postoperative urinary retention, or risk of urinary tract infection between groups. <h3>Conclusion</h3> Retrofilling the bladder in the operating room after outpatient gynecologic surgery reduces the time to first void and discharge with no increase in adverse events.