Retrograde Bladder Filling after Laparoscopic Gynecologic Surgery: A Double-blind Randomized Controlled Trial

Abstract

To evaluate whether retrofilling the bladder on completion of elective laparoscopic gynecologic surgery for benign indications has an effect on the timing of the first postoperative void and the timing of discharge from the hospital. Design: Double-blind randomized controlled trial. Setting: Single academic surgical day hospital. Patients: Patients undergoing outpatient laparoscopic gynecologic surgery, excluding hysterectomy or pelvic reconstructive surgery. Interventions: On completion of surgery, patients were randomized to either retrograde filling of the bladder with 200 mL of saline before catheter removal or standard care (immediate catheter removal). Patients and postanesthesia care unit nurses (outcome assessors) were both blinded. Measurements and Main Results: The primary outcome was the time to first void. The secondary outcomes were time to hospital discharge, postoperative urinary tract infection, and patient satisfaction. Over a 3-month period, 47 patients were approached on the day of surgery, 42 consented and were randomized (21 to intervention and 21 to control). There were no significant differences in baseline demographics between the groups. The median time to first void was significantly shorter for patients in the intervention arm than controls (104 § 75 minutes vs 162 § 76 minutes, p <.001). Patients who had retrofilled bladders were discharged faster from post-anesthesia care unit compared to controls (155.0 § 74 minutes vs 227 § 58 minutes, p = .001). There were no urinary tract infections in either group, and the proportion of satisfied or very satisfied patients was high (93.8% vs 88.2%, p = .512). Conclusion: Retrograde filling of the bladder after outpatient laparoscopic gynecologic surgery is a safe, effective method that significantly reduces the length of hospital stay.

Bladder Backfilling versus Standard Catheter Removal for Trial of Void after Outpatient Laparoscopic Gynecologic Surgery: A Systematic Review and Meta-Analysis

“…Filling the bladder to submicturition levels after hysterectomy minimizes the length of the stay in the recovery unit [16]. The present study shows that the bladder backfilling TOV is not superior to the standard catheter removal TOV with or without the study by Zakhari et al [13] (which excluded laparoscopic hysterectomy). This is a question worth considering.…”

“…After exclusion of duplicate or irrelevant references, 15 full-text articles were assessed for eligibility. After a detailed evaluation of these articles, only 5 RCTs [8,[13][14][15][16] comprising 488 patients were included in the quantitative synthesis of this systematic review (Supplementary Fig. 1).…”

Retrograde Bladder Filling After Outpatient Gynecologic Surgery

“…Three studies reported unanticipated postoperative medical visits with variable follow-up durations (1 week, 2 weeks, and up to 8 weeks). 8–10 There were low numbers of unanticipated medical visits in all studies and groups, with no differences between the retrofill and passive fill groups in any of the studies. Two studies evaluated postoperative bladder function and found no differences in urinary symptoms and bladder pain between the retrofill and passive fill groups.…”

“…Int J Gynecol Obstet 2018;143:334–5). 5–10 Retrofilling the bladder resulted in a significantly shorter time to discharge (mean difference –32.0 minutes; 95% CI −51.5 to −12.6, eight studies, 1,164 patients, P =.001, I 2 =64%, random effects model) (Fig. 3).…”

“…Three studies reported patient satisfaction using a Likert scale. 7,8,10 There was no difference between the intervention and control groups in the proportion of patients reporting being satisfied or very satisfied with the intervention (RR 0.95; 95% CI 0.82 to 1.10, three studies, 234 patients, P =.48, I 2 =37%, random effects model). Three studies reported unanticipated postoperative medical visits with variable follow-up durations (1 week, 2 weeks, and up to 8 weeks).…”