Assessment of Voiding After Sling. Issue 8 (August 2015)

• Record Type: Journal Article
• Authors: Tunitsky-Bitton, Elena; Murphy, Alana; Barber, Matthew D.; Goldman, Howard B.; Vasavada, Sandip; Jelovsek, J. Eric
• Is Part Of: Obstetrical & gynecological survey. Volume 70:Issue 8(2015)
• Publication Date: 2015-08
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; Generative organs, Female -- Surgery -- Periodicals; 618
• DOI: 10.1097/OGX.0000000000000222
• Languages: English
• ISSNs: 0029-7828

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>ABSTRACT</title> <p>Indwelling catheters are the leading cause of hospital-acquired urinary tract infections and are a source of discomfort, embarrassment, and inconvenience for patients. An assessment of voiding function (voiding trial) after anti-incontinence surgery is often performed to determine which patients can be safely discharged without a catheter. The backfill standard voiding trial (SVT) is a commonly used method to evaluate postoperative urinary retention. Standard voiding trial provides an objective assessment of postoperative voiding function. It involves filling the bladder with 300 mL of sterile fluid via the catheter in the recovery room, removing the catheter, allowing the patient to void, and measuring the voided urine. If the voided amount is more than two-thirds the infused volume, the patient is discharged without an indwelling catheter. In an alternative subjective method, a visual analog scale is used to determine the urinary force of stream (FOS) before and after surgery. The criteria for discharge without a catheter with this method are a report by the patient that her FOS is 50% or greater of her baseline FOS regardless of the amount voided. The FOS voiding trial appears to be safe, but it is not known whether a patient's subjective perception of voiding correlates with SVT results.</p> <p>The aim of this double-blind randomized comparative trial was to determine if the subjective patient evaluation with the FOS voiding trial is a safe method to determine the need for indwelling catheterization after outpatient sling surgery. The authors tested the hypothesis that the rate of catheterization would be significantly lower when using the FOS technique as compared with the backfill SVT. Patients in both groups had undergone an outpatient midurethral sling procedure for female stress urinary incontinence without any other concomitant surgery. All participants underwent the same standardized postoperative protocol in the recovery room.</p> <p>Participants were interviewed and completed questionnaires at 4 time points: preoperatively and 2 to 4 days, 7 to 9 days, and 6 weeks postoperatively. The primary study outcome was the rate of catheterization within 6 weeks after the surgery. All postoperative interviews assessed pain, tolerance of physical activity, urinary FOS, and satisfaction with the surgery. Urinary symptoms were evaluated by use of validated questionnaires (Incontinence Severity Index and Urinary Distress Inventory, Short Form) before the surgery and 6 weeks postoperatively.</p> <p>Six-week follow-up data were available for 102 of the 108 participants who had enrolled and were randomized (50 in the FOS trial and 52 in the SVT). Demographic characteristics and urinary symptoms were similar in the 2 groups. The catheterization rate was similar in the 2 groups (FOS 13 [26%], SVT 13 [25.5%]; <italic>P</italic> = 0.95). There was a moderate correlation between the 2 groups for the amount voided (Spearman ρ = 0.5; <italic>P</italic> < 0.001). Postoperative evaluation showed no significant group differences in mean catheter days, pain scores, Incontinence Severity Index, and Urinary Distress Inventory, Short Form scores. None of the patients discharged home without a catheter in either group required catheter reinsertion within 6 weeks after the surgery.</p> <p>Subjective evaluation of the FOS is a reliable and safe method to assess continence after outpatient midurethral surgery. There was no difference in catheterization rate between these 2 voiding trials, and the patient's subjective assessment of FOS correlated well with the measured voided amount in the SVT.</p> </sec> </abstract>