A Systematic Review of Randomized Trials Investigating Methods of Postoperative Void Trials Following Benign Gynecologic and Urogynecologic Surgeries

Abstract

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A risk calculator for postoperative urinary retention (POUR) following vaginal pelvic floor surgery: multivariable prediction modelling

“…This is in keeping with several studies that have used the same type of postoperative voiding protocol 4,45,47 . A lower threshold for voiding success using a 1:1 ratio would reduce the recorded rates of POUR, as demonstrated in the minority of patients where a 1:1 voiding protocol was used in this study, and would therefore decrease the number of patients discharged with a catheter 48 . However, this more lenient criteria may increase the rate of emergency presentations with urinary retention, which was not assessed in this study.…”

“…4,45,47 A lower threshold for voiding success using a 1:1 ratio would reduce the recorded rates of POUR, as demonstrated in the minority of patients where a 1:1 voiding protocol was used in this study, and would therefore decrease the number of patients discharged with a catheter. 48 However, this more lenient criteria may increase the rate of emergency presentations with urinary retention, which was not assessed in this study. The predictive model that we used to calculate POUR risk in the present study did not take into consideration the type of voiding protocol (2:1 vs 1:1), as the present model only included variables determined before and during surgery.…”

“…A recent systematic review evaluated the criteria used to define a successful voiding trial after pelvic reconstructive surgery and found significant inconsistencies between trials, with no observable differences between the various criteria. 48 The majority of patients in the present study underwent a voiding protocol using a passing definition of a 2:1 ratio of voided volume to PVR. This is in keeping with several studies that have used the same type of postoperative voiding protocol.…”

Wide Variation in Post-Void Residual Management after Urogynecologic Surgery: A Survey of Urogynecologists’ Practices

“…These findings and heterogeneous responses highlight that there is no consensus of critical thresholds, and confirm that the cut-off values used by clinicians range significantly [ 4 ]. A 2021 systematic review of randomized controlled trials (RCT) investigating postoperative voiding trials, similarly summarized that the most significant inconsistency was the PVR criteria for a successful voiding trial, ranging from 100 mL to 500 mL [ 21 ]. A generally accepted cut-off level for urinary retention is not defined by the International Continence Society or any other national or international society [ 22 ].…”

Early Discontinuation, Results Reporting, and Publication of Gynecology Clinical Trials From 2007 to 2020

“…Existing studies examining clinical trials in gynecology cover only small samples of trials over short time periods, with limited discussion of subspecialties. [11][12][13][14] As one of the largest registries in the world, ClinicalTrials.gov captures nearly half of all global trials and presents an exemplar database to investigate gynecology trials. 15 Given the importance of clinical trials as a scaffold for evidence-based medicine, we aimed to identify the key drivers of three outcomes that capture clinical trial success-completion, results reporting, and publication-with a focus on the effect of subspecialty and funding.…”