Cost-effectiveness of Routine Postoperative Retrograde Voiding Trials Following Pelvic Surgeries

Wang, Rui; Soeteman, Djøra I.; Hacker, Michele R.; Lefevre, Roger

doi:10.1097/spv.0000000000000577

Cited by 5 publications

(1 citation statement)

References 20 publications

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“…Currently, the back ll VT has been shown to have greater accuracy [21] and cost savings than the auto ll method [22]. When comparing the time to discharge, we did not nd evidence to support the superiority of back ll assistance.…”

Section: Discussionmentioning

confidence: 59%

Methods of postoperative void trial management after urogynecologic surgery ： a systematic review and meta-analysis

Dong

Niu

et al. 2022

Preprint

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Background: To systematically review and meta-analyze postoperative void trials (VTs) following urogynecologic surgery to investigate (1) the optimal postoperative VT methodology and (2) the optimal criteria for assessing VT. Method: We searched the PubMed, EMBASE, Cochrane Library, Ovid Medline, and relevant reference lists of eligible articles up to April 2022. This review included randomized controlled trials (RCTs). Relative risks (RRs) and weighted mean differences (WMDs), each with 95% confidence intervals (CIs) were also calculated. The risk of bias was assessed using the Cochrane Risk of Bias tool. Results: VT methodology included backfill-assisted and autofill studies (two RCTs, n=95). Backfill assistance was more likely to be successful than autofill (RR 2.12, 95% CI 1.29, 3.47, P = .00); however, no significant difference was found in the time to discharge (WMDs= –29.11 min, 95% CI -57.45, 1.23, P = .06). Criteria for passing VT included subjective assessment of the urinary force of stream (FOS) and objective assessment of the standard voiding trial (SVT) (3 RCTs, n=377). No significant differences were found in the correct passing rate (RR 0.97, 95% CI 0.93, 1.01, P = .14) or VT failure rate (RR 0.78, 95% CI 0.52,1.18, P = .24). Moreover, no significant differences were found in the complication rates orpatient satisfaction between the two criteria. Conclusion: Bladder backfilling was associated with a lower rate of catheter discharge after urogynecologic surgery. The subjective assessment of FOS is a reliable and safe method for assessing postoperative voiding because it is less invasive. Systematic review registration: PROSPERO CRD42022313397.

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Section: Discussionmentioning

confidence: 59%

Methods of postoperative void trial management after urogynecologic surgery ： a systematic review and meta-analysis

Dong

Niu

et al. 2022

Preprint

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Optimal timing of a second postoperative voiding trial in women with incomplete bladder emptying after vaginal reconstructive surgery: a randomized trial

Schachar

Ossin

Plair

et al. 2020

American Journal of Obstetrics and Gynecology

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Active versus Passive Voiding Protocols after Same-day Minimally Invasive Hysterectomy

Ishino

Tucker

Navarrete

et al. 2022

Journal of Minimally Invasive Gynecology

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To determine the proportion of patients discharged with a urinary catheter after a same-day benign gynecologic minimally invasive hysterectomy (MIH) according to active vs passive voiding protocols. The secondary objectives included assessing postanesthesia care unit (PACU) duration and postoperative urinary retention (POUR) rate ≤2 weeks of discharge. Design: Retrospective, observational cohort study. Setting: Large integrated healthcare system serving approximately 40% of the Northern California population. Patients: Patients aged 18 years or older undergoing same-day MIH without urogynecology procedures from 2015 to 2018 were categorized into active or passive voiding trial groups. Active voiding trials were defined as patients arriving in the PACU with a catheter, retrograde filling of the bladder with 300 mL saline then allowing for voiding ≥50% within 30 minutes. If the patients were unable to void this volume, they were discharged with a catheter to be removed within 24 hours. A passive voiding trial involved filling or not filling the bladder before PACU arrival without a catheter, then allowing for voiding or performing a straight catheterization if the patients were unable to void. Interventions: Retrospective cohort study. Measurements and Main Results: A total of 1644 (83.2%) patients underwent passive voiding trials, and 333 (16.8%) underwent active voiding trials. The proportion of patients discharged with a catheter was lower in the passive voiding group than in the active voiding group (5.4% vs 10.5%; p = .001). The passive group had a shorter mean PACU time than the active group (218 § 86 vs 240 § 93 minutes; p <.001). The crude POUR rates for the passive and active voiding groups were 1.8% and 3.0%, respectively (p = .16). Conclusion: Within an integrated healthcare system, patients who underwent passive voiding trials compared with those who underwent active voiding trials were discharged home from the PACU after a shorter duration. In addition, a larger proportion of the patients who underwent passive voiding trials were discharged home without a urinary catheter. There were no differences in the POUR rates. Our findings suggest that passive voiding trials can be safely used after a benign MIH to reduce hospital duration, optimize healthcare resources, and improve patient experience.

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Cost-effectiveness of Routine Postoperative Retrograde Voiding Trials Following Pelvic Surgeries

Cited by 5 publications

References 20 publications

Methods of postoperative void trial management after urogynecologic surgery ： a systematic review and meta-analysis

Methods of postoperative void trial management after urogynecologic surgery ： a systematic review and meta-analysis

Optimal timing of a second postoperative voiding trial in women with incomplete bladder emptying after vaginal reconstructive surgery: a randomized trial

Active versus Passive Voiding Protocols after Same-day Minimally Invasive Hysterectomy

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