Voiding Trial in Office after Unsuccessful Voiding Trial in Postoperative Unit: How Many More Days Is Enough?

Study Objective: To determine the incidence of a successful in-office voiding trial after minimally invasive hysterectomy. Design: A retrospective cohort study. Setting: A tertiary care academic center. Patients: All patients undergoing minimally invasive hysterectomies (vaginal, laparoscopic, or robotic) from January 2013 to July 2018 who have an unsuccessful voiding trial in the postoperative unit. Interventions: A voiding trial. Measurements and Main Results: Of 558 outpatient hysterectomies (with same-day discharge) performed in the time period of interest, 174 patients were discharged home with a Foley catheter (31%). Of those patients, 37% presented for a repeat in-office voiding trial at less than 3 postoperative days, 31% presented at 3 postoperative days, and 31.6% presented at more than 3 postoperative days. Eighty-six percent of patients presenting for their first in-office voiding trial were successful at voiding. There were no differences noted in age, gravity, parity, the use of hormone replacement therapy, menopausal status, smoking, hypertension, or diabetes in patients who passed their first in-office voiding trial compared with those who did not. Vaginal hysterectomy was the most common route of hysterectomy and was performed in 57% of cases followed by robotic hysterectomy in 32%. There were no differences noted in the indication or route of hysterectomy between patients who pass or fail their first in-office voiding trial. At the time of hysterectomy, 47% of patients had concomitant female pelvic medicine and reconstructive surgery procedures performed (midurethral sling, periurethral injections, or colporrhaphy). The incidence of urinary tract infections in this patient cohort was 12%, but the incidence was significantly higher in patients who failed compared with those who passed their first in-office voiding trial (37.3% vs 7.3%, p <.001). After adjusting for age, hysterectomy route, and concomitant female pelvic medicine and reconstructive surgery procedures performed, the number of postoperative days at the time of the first in-office voiding trial does not predict success. Conclusion: The timing of the repeat in-office voiding trial in posthysterectomy patients who fail their initial voiding trial in the postanesthesia care unit was not related to success. The incidence of urinary tract infections is higher in patients who fail their repeat voiding trial because recatheterization and a longer duration of catherization are necessary.