Diagnostic Accuracy of Retrograde and Spontaneous Voiding Trials for Postoperative Voiding Dysfunction

Geller, Elizabeth J.; Hankins, Kelly J.; Parnell, Brent A.; Robinson, Barbara L.; Dunivan, Gena C.

doi:10.1097/aog.0b013e318229e8dd

Cited by 64 publications

(54 citation statements)

References 13 publications

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“…Patients undergoing midurethral mesh sling and/or prolapse repair underwent both voiding trial techniques but were randomized as to which one was performed first. The rate of POUR (defined as failure of voiding trial) on day of hospital discharge was predictably higher on the basis of strict definition of PVR: 84% for the spontaneous fill method and 62% for the retrograde method 6. The retrograde method had 94.4% sensitivity and 58.1% specificity to detect prolonged POUR lasting at least 7 days, compared with the spontaneous method with 100% sensitivity and 25.8% specificity.…”

Section: Managementmentioning

confidence: 97%

“…A significant challenge in the diagnosis of POUR comes from the fact that there is no universal definition of urinary retention, either postoperative or otherwise. When using the broader definition of “voiding dysfunction” to characterize postoperative bladder function, estimates are even higher, with a range of 39%–84% 5,6. These higher rates include any transient voiding dysfunction that is documented in the postoperative period, as early as in the recovery room.…”

Section: Introductionmentioning

confidence: 99%

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Prevention and management of postoperative urinary retention after urogynecologic surgery

Geller¹

2014

IJWH

130

116

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Postoperative urinary retention (POUR) is a frequent consequence of gynecologic surgery, especially with surgical correction of urinary incontinence and pelvic organ prolapse. Estimates of retention rates after pelvic surgery range from 2.5%–43%. While there is no standard definition for POUR, it is characterized by impaired bladder emptying, with an elevation in the volume of retained urine. The key to management of POUR is early identification. All patients undergoing pelvic surgery, especially for the correction of incontinence or prolapse, should have an assessment of voiding function prior to discharge. There are several ways to assess voiding function – the gold standard is by measuring a postvoid residual. Management of POUR is fairly straightforward. The goal is to decompress the bladder to avoid long-term damage to bladder integrity and function. The decision regarding when to discontinue catheter-assisted bladder drainage in the postoperative period can be assessed in an ongoing fashion by measurement of postvoid residual. The rate of prolonged POUR beyond 4 weeks is low, and therefore most retention can be expected to resolve spontaneously within 4–6 weeks. When POUR does not resolve spontaneously, more active management may be required. Techniques include urethral dilation, sling stretching, sling incision, partial sling resection, and urethrolysis. While some risk of POUR is inevitable, there are risk factors that are modifiable. Patients that are at higher risk – either due to the procedures being performed or their clinical risk factors – should be counseled regarding the risks and management options for POUR prior to their surgery. Although POUR is a serious condition that can have serious consequences if left untreated, it is easily diagnosed and typically self-resolves. Clinician awareness of the condition and vigilance in its diagnosis are the key factors to successful care for patients undergoing surgical repair.

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Section: Managementmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Prevention and management of postoperative urinary retention after urogynecologic surgery

Geller¹

2014

IJWH

130

116

View full text Add to dashboard Cite

show abstract

“…In addition, postoperative voiding trials routinely use transurethral catheterization, which can be uncomfortable and has been shown to decrease overall patient satisfaction with surgical outcomes [8]. As voiding trials have low specificity for detecting postoperative urinary dysfunction (58 % for retrograde and 26 % for spontaneous voiding trials) [9], women may be discharged with indwelling catheters or intermittent self-catheterization unnecessarily. As the prevalence of surgical treatment for pelvic floor disorders increases with the increasing elderly and obese populations [10], the potential for overuse will continue to increase.…”

Section: Introductionmentioning

confidence: 99%

Voiding trial outcome following pelvic floor repair without incontinence procedures

et al. 2016

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Introduction and hypothesis Our aim was to identify predictors of postoperative voiding trial failure among patients who had a pelvic floor repair without a concurrent incontinence procedure in order to identify low-risk patients in whom postoperative voiding trials may be modified. Methods We conducted a retrospective cohort study of women who underwent pelvic floor repair without concurrent incontinence procedures at two institutions from 1 November 2011 through 13 October 2013 after abstracting demographic and clinical data from medical records. The primary outcome was postoperative retrograde voiding trial failure. We used modified Poisson regression to calculate the risk ratio (RR) and 95 % confidence interval (CI). Results Of the 371 women who met eligibility criteria, 294 (79.2 %) had complete data on the variables of interest. Forty nine (16.7%) failed the trial, and those women were less likely to be white (p = 0.04), more likely to have had an anterior colporrhaphy (p = 0.001), and more likely to have had a preoperative postvoid residual (PVR) ≥150 ml (p = 0.001). After adjusting for race, women were more likely to fail their voiding trial if they had a preoperative PVR of ≥150 ml (RR: 1.9; 95 % CI: 1.1–3.2); institution also was associated with voiding trial failure (RR: 3.0; 95 % CI: 1.6–5.4). Conclusions Among our cohort, postoperative voiding trial failure was associated with a PVR of ≥150 ml and institution at which the surgery was performed.

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“…Prevalence rates that include transient voiding dysfunction documented in the recovery room range between 39% and 84% (Geller et al, 2007). Although prolonged retention (lasting longer than 4 weeks post-operative) is rarer, the rates for TVT slings are around 2%-4% (Natale et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

ISC in women following urogynaecologic surgery

Bardsley

2015

Br J Nurs

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Urinary retention is a common problem for women following surgery and a significant complication for those who have undergone urogynecologic surgery with prevalence estimated between 2.5% and 24% (Dorflinger and Monga, 2001). Post-operative urinary retention (POUR) can lead to bladder distention, causing altered bladder function, urinary tract infections and poor surgical outcomes. Intermittent self-catheterisation (ISC) for women is generally considered in preference to in-dwelling catheterisation wherever possible. This article aims to explore the role of ISC for women following surgery.

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Diagnostic Accuracy of Retrograde and Spontaneous Voiding Trials for Postoperative Voiding Dysfunction

Abstract: I.

Cited by 64 publications

References 13 publications

Prevention and management of postoperative urinary retention after urogynecologic surgery

Prevention and management of postoperative urinary retention after urogynecologic surgery

Voiding trial outcome following pelvic floor repair without incontinence procedures

ISC in women following urogynaecologic surgery

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