Predictors for Voiding Trial Failure after Minimally Invasive Sacrocolpopexy

Abstract

Introduction: Catheter associated urinary tract infections (CAUTIs) due to indwelling catheters pose a serious health and financial burden in the US. Patients who undergo reconstructive pelvic surgery experience postoperative voiding dysfunction at a significant rate, requiring prolonged catheterization. The preoperative identification of patients at highest risk of failing a backfill trial of void (TOV) would allow for selected instruction in self-catheterization techniques and minimize the prevalence in dwelling catheters.Objective: To identify predictors for voiding trial failure after minimally-invasive (laparoscopic or robot-assisted) sacrocolpopexy for surgical correction of prolapse in patients who did not undergo a concomitant urinary anti-incontinence procedure.Methods: All subjects undergoing minimally-invasive sacrocolpopexy without concomitant anti-incontinence surgery from October 2006 to July 2010 at our institution were included. Patient characteristics including basic demographics, medical and surgical history, operative characteristics, and baseline preoperative urodynamic testing were included. The data was analyzed with logistic regression for continuous variables and Pearson chi-squared test for dichotomous variables (Stata IC-13).Results: 56 subjects were identified. Of those, 5 subjects (8.9%) failed a postoperative voiding trial. No significant association between examined variables and failure of trial of void were observed. Concomitant vaginal surgery approached significance with a p-value of 0.058. Conclusion:The percentage of subjects that failed a voiding trail was comparable to that described in the minimally invasive literature. Providers should educate all patients undergoing minimally invasive sacrocolpopexy as to self-catheterization techniques given the inability to identify preoperative risk factors.