1
|
Popiel P, Swallow C, Choi JE, Jones K, Xu X, Harmanli O. Assessment of patient satisfaction with home vs office indwelling catheter removal placed for urinary retention after female pelvic floor surgery: a randomized controlled trial. Am J Obstet Gynecol 2023; 229:312.e1-312.e8. [PMID: 37330128 DOI: 10.1016/j.ajog.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/10/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Postoperative urinary retention is burdensome for patients. We seek to improve patient satisfaction with the voiding trial process. OBJECTIVE This study aimed to assess patient satisfaction with location of indwelling catheter removal placed for urinary retention after urogynecologic surgery. STUDY DESIGN All adult women who were diagnosed with urinary retention requiring postoperative indwelling catheter insertion after undergoing surgery for urinary incontinence and/or pelvic organ prolapse were eligible for this randomized controlled study. They were randomly assigned to catheter removal at home or in the office. Those who were randomized to home removal were taught how to remove the catheter before discharge, and were discharged home with written instructions, a voiding hat, and 10-mL syringe. All patients had their catheter removed 2 to 4 days after discharge. Those patients who were allocated to home removal were contacted in the afternoon by the office nurse. Subjects who graded their force of urine stream 5, on a scale of 0 to 10, were considered to have safely passed their voiding trial. For patients randomized to the office removal group, the voiding trial consisted of retrograde filling the bladder to maximum they could tolerate up to 300 mL. Urinating >50% of instilled volume was considered successful. Those who were unsuccessful in either group had catheter reinsertion or self-catheterization training in the office. The primary study outcome was patient satisfaction, measured based on patients' response to a question, "How satisfied were you with the overall removal process of the catheter?" A visual analogue scale was created to assess patient satisfaction and 4 secondary outcomes. A sample size of 40 participants per group were needed to detect a 10 mm difference in satisfaction between groups on the visual analogue scale. This calculation provided 80% power and an alpha of 0.05. The final number accounted for 10% loss to follow up. We compared the baseline characteristics, including urodynamic parameters, relevant perioperative indices, and patient satisfaction between the groups. RESULTS Of the 78 women enrolled in the study, 38 (48.7%) removed their catheter at home and 40 (51.3%) had an office visit for catheter removal. Median and interquartile range for age, vaginal parity, and body mass index were 60 (49-72) years, 2 (2-3), and 28 (24-32) kg/m2, respectively, in the overall sample. Groups did not differ significantly in age, vaginal parity, body mass index, previous surgical history, or type of concomitant procedures. Patient satisfaction was comparable between the groups, with a median score (interquartile range) of 95 (87-100) in the home catheter removal group and 95 (80-98) in the office catheter removal group (P=.52). Voiding trial pass rate was similar between women who underwent home (83.8%) vs office (72.5%) catheter removal (P=.23). No participants in either group had to emergently come into the office or hospital due to inadequate voiding afterwards. Within 30 days post operatively, a lower proportion of women in the home catheter removal group (8.3%) had urinary tract infection, compared to patients in the office catheter removal group (26.3%) (P=.04). CONCLUSION In women with urinary retention after urogynecologic surgery, there is no difference in satisfaction concerning the location of indwelling catheter removal when comparing home and office.
Collapse
Affiliation(s)
- Patrick Popiel
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY.
| | | | - Jennie Eunsook Choi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Keisha Jones
- Department of Obstetrics and Gynecology, Baystate Medical Center, University of Massachusetts Medical School, Springfield, MA
| | - Xiao Xu
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY; Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Oz Harmanli
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| |
Collapse
|
2
|
Dong X, Huang W, Niu J, Lei T, Tan X, Guo T. Methods of postoperative void trial management after urogynecologic surgery: a systematic review and meta-analysis. Syst Rev 2023; 12:115. [PMID: 37420310 PMCID: PMC10327332 DOI: 10.1186/s13643-023-02233-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/06/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Voiding trials are used to identify women at risk for postoperative urinary retention while performing optimal voiding trial management with minimal burden to the patient and medical service team. We performed a systematic review and meta-analysis of postoperative void trials following urogynecologic surgery to investigate (1) the optimal postoperative void trial methodology and (2) the optimal criteria for assessing void trial. METHOD We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and relevant reference lists of eligible articles from inception to April 2022. We identified any randomized controlled trials (RCTs) in English that studied void trials in patients undergoing urogynecologic surgery. Study selection (title/abstract and full text), data extraction, and risk of bias assessment were conducted by two independent reviewers. Extracted study outcomes included the following: the correct passing rate, time to discharge, discharge rate without a catheter after the initial void trial, postoperative urinary tract infection, and patient satisfaction. RESULTS Void trial methodology included backfill-assisted and autofill studies (2 RCTs, n = 95). Backfill assistance was more likely to be successful than autofill (RR 2.12, 95% CI 1.29, 3.47, P = 0.00); however, no significant difference was found in the time to discharge (WMDs = - 29.11 min, 95% CI - 57.45, 1.23, P = 0.06). The criteria for passing void trial included subjective assessment of the urinary force of stream and objective assessment of the standard voiding trial (3 RCTs, n = 377). No significant differences were found in the correct passing rate (RR 0.97, 95% CI 0.93, 1.01, P = 0.14) or void trial failure rate (RR 0.78, 95% CI 0.52, 1.18, P = 0.24). Moreover, no significant differences were found in the complication rates or patient 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.
Collapse
Affiliation(s)
- Xue Dong
- Ambulatory Surgery Department, West China Second Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Gynecology and Obstetrics Department, West China Second Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China
| | - Wu Huang
- Gynecology and Obstetrics Department, People's Hospital of Pidu District, Chengdu, 611730, Sichuan, China
| | - Jinyang Niu
- Gynecology and Obstetrics Department, Panzhihua Central Hospital, Panzhihua, 617000, Sichuan, China
| | - Tingting Lei
- Gynecology and Obstetrics Department, Suining Municipal Hospital of Traditional Chinese Medical, Suining, 629000, Sichuan, China
| | - Xin Tan
- Ambulatory Surgery Department, West China Second Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
- Gynecology and Obstetrics Department, West China Second Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China.
| | - Tao Guo
- Gynecology and Obstetrics Department, West China Second Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
3
|
Nutaitis AC, Meckes NA, Madsen AM, Toal CT, Menhaji K, Carter-Brooks CM, Propst KA, Hickman LC. Postpartum urinary retention: an expert review. Am J Obstet Gynecol 2023; 228:14-21. [PMID: 35932877 DOI: 10.1016/j.ajog.2022.07.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/24/2022] [Accepted: 07/31/2022] [Indexed: 01/26/2023]
Abstract
Postpartum urinary retention is a relatively common condition that can have a marked impact on women in the immediate days following childbirth. If left untreated, postpartum urinary retention can lead to repetitive overdistention injury that may damage the detrusor muscle and the parasympathetic nerve fibers within the bladder wall. In rare circumstances, postpartum urinary retention may even lead to bladder rupture, which is a potentially life-threatening yet entirely preventable complication. Early diagnosis and timely intervention are necessary to decrease long-term consequences. There are 3 types of postpartum urinary retention: overt, covert, and persistent. Overt retention is associated with an inability to void, whereas covert retention is associated with incomplete bladder emptying. Persistent urinary retention continues beyond the third postpartum day and can persist for several weeks in rare cases. Recognition of risk factors and prompt diagnosis are important for proper management and prevention of negative sequelae. However, lack of knowledge by providers and patients alike creates barriers to accessing and receiving evidence-based care, and may further delay diagnosis for patients, especially those who experience covert postpartum urinary retention. Nationally accepted definitions and management algorithms for postpartum urinary retention are lacking, and development of such guidelines is essential for both patient care and research design. We propose intrapartum recommendations and a standardized postpartum bladder management protocol that will improve patient outcomes and contribute to the growing body of evidence-based practice in this field.
Collapse
Affiliation(s)
- Alexandra C Nutaitis
- Department of Obstetrics and Gynecology, Cleveland Clinic Akron General, Akron, OH
| | - Nicole A Meckes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, PA
| | - Annetta M Madsen
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Coralee T Toal
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, PA
| | - Kimia Menhaji
- Female Pelvic Medicine and Reconstructive Surgery, West Coast Ob/Gyn Inc, San Diego, CA; Division of Female Pelvic Medicine and Reconstructive surgery, Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Charelle M Carter-Brooks
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Katie A Propst
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL
| | - Lisa C Hickman
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH.
| |
Collapse
|
4
|
Anglim BC, Ramage K, Sandwith E, Brennand EA. Postoperative urinary retention after pelvic organ prolapse surgery: influence of peri-operative factors and trial of void protocol. BMC Womens Health 2021; 21:195. [PMID: 33975584 PMCID: PMC8111911 DOI: 10.1186/s12905-021-01330-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/23/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Transient postoperative urinary retention (POUR) is common after pelvic floor surgery. We aimed to determine the association between peri-operative variables and POUR and to determine the number of voids required for post-void residuals (PVRs) to normalize postoperatively. METHODS We conducted a retrospective cohort study of 992 patients undergoing pelvic floor surgery at a tertiary referral centre from January 2015 to October 2017. Variables assessed included: age, BMI, ASA score, anaesthesia type, type of surgery, length of postoperative stay, surgeon, bladder protocol used, and number of PVRs required to "pass" the protocol. RESULTS Significant risk factors for POUR included: placement of MUS during POP surgery, anterior repair and hysterectomy with concomitant sacrospinous vault suspension. A total of 25.1% were discharged requiring catheterization. Patients receiving a concomitant mid-urethral sling (MUS) were 2.2 (95% CI1.6-2.9) and 2.3 (95% CI 1.8-3.1) times more likely to have elevated PVR after their second TOV and third TOV (p < 0.0001), respectively, compared with those without concomitant MUS. Permitting a third TOV allowed an additional 10% of women to pass the voiding protocol before discharge. The median number of voids to pass protocol was 2. An ASA > 2 and placement of MUS were associated with increasing number of voids needed to pass protocol. CONCLUSIONS While many women passed protocol by the second void, using the 3rd void as a cut point to determine success would result in fewer women requiring catheterization after discharge. Prior to pelvic floor surgery, women should be counselled regarding POUR probability to allow for management of postoperative expectations.
Collapse
Affiliation(s)
- B C Anglim
- Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynaeacology, Foothills Medical Centre, School of Medicine, University of Calgary, 1403 29 Street Northwest, Calgary, AB, T2N 2T9, Canada.
| | - K Ramage
- Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynaeacology, Foothills Medical Centre, School of Medicine, University of Calgary, 1403 29 Street Northwest, Calgary, AB, T2N 2T9, Canada
| | - E Sandwith
- Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynaeacology, Foothills Medical Centre, School of Medicine, University of Calgary, 1403 29 Street Northwest, Calgary, AB, T2N 2T9, Canada
| | - E A Brennand
- Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynaeacology, Foothills Medical Centre, School of Medicine, University of Calgary, 1403 29 Street Northwest, Calgary, AB, T2N 2T9, Canada
| |
Collapse
|