Voiding trial outcome following pelvic floor repair without incontinence procedures

Abstract

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.

Postoperative Urinary Retention after Pelvic Organ Prolapse Surgery – Influence of Peri-operative Factors and Trial of Void Protocol

“…Previous studies have shown that lower BMI, older women and anterior colporrhaphy are associated with higher risk of POUR [8][9][10][11][12]. In our analysis we found only modest differences in the reconstructive vs. obliterative approaches.…”

“…Small peripheral nerve endings required for bladder sensation can become temporarily disrupted, resulting in a transient neuropathy and resultant bladder dysfunction [4]. Previously evaluated risk factors for POUR include: lower body mass index (BMI), advanced age, higher stage of prolapse, anterior colporrhaphy, previous incontinence surgery, and high preoperative post void residuals (PVR) [8][9][10][11][12]. Intravenous uid administration of >750mL or a bladder volume of > 270mL in the postanaesthetic recovery area has also been shown to increase the risk of POUR [13].…”

Postoperative urinary retention after pelvic organ prolapse surgery: influence of peri-operative factors and trial of void protocol

“…Previous studies have shown that lower BMI, older women and anterior colporrhaphy are associated with higher risk of POUR [ 8 – 12 ]. In our analysis we found only modest differences in the reconstructive vs. obliterative approaches.…”

“…Small peripheral nerve endings required for bladder sensation can become temporarily disrupted, resulting in a transient neuropathy and resultant bladder dysfunction [ 4 ]. Previously evaluated risk factors for POUR include: lower body mass index (BMI), advanced age, higher stage of prolapse, anterior colporrhaphy, previous incontinence surgery, and high preoperative post void residuals (PVR) [ 8 – 12 ]. Intravenous fluid administration of > 750 mL or a bladder volume of ≥ 270 mL in the postanaesthetic recovery area has also been shown to increase the risk of POUR [ 13 ].…”

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

“…4,6,7 They can help increase the detection of transient postoperative voiding dysfunction when compared to the traditional practice of monitoring for spontaneous voiding. However, evidence indicates that the risk of postoperative voiding dysfunction varies from 2% to 43% depending on the type of pelvic procedure 2,4,8–12 and there is still no consensus on the routine use of voiding trials following pelvic surgeries.…”