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

Sadikah Behbehani, Tiffany Pham, Katie Kunze, Megan Wasson, Johnny Yi

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalJournal of Minimally Invasive Gynecology
DOIs
StatePublished - Jan 1 2019

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Hysterectomy
Reconstructive Surgical Procedures
Vaginal Hysterectomy
Incidence
Robotics
Urinary Tract Infections
Medicine
Suburethral Slings
Hormone Replacement Therapy
Gravitation
Parity
Tertiary Care Centers
Cohort Studies
Outpatients
Catheters
Retrospective Studies
Smoking
Hypertension
Injections

Keywords

  • Minimally invasive hysterectomy
  • Outpatient hysterectomy
  • Urinary retention
  • Voiding trial

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Voiding Trial in Office after Unsuccessful Voiding Trial in Postoperative Unit : How Many More Days Is Enough? / Behbehani, Sadikah; Pham, Tiffany; Kunze, Katie; Wasson, Megan; Yi, Johnny.

In: Journal of Minimally Invasive Gynecology, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Voiding Trial in Office after Unsuccessful Voiding Trial in Postoperative Unit: How Many More Days Is Enough?",
abstract = "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.",
keywords = "Minimally invasive hysterectomy, Outpatient hysterectomy, Urinary retention, Voiding trial",
author = "Sadikah Behbehani and Tiffany Pham and Katie Kunze and Megan Wasson and Johnny Yi",
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T2 - How Many More Days Is Enough?

AU - Behbehani, Sadikah

AU - Pham, Tiffany

AU - Kunze, Katie

AU - Wasson, Megan

AU - Yi, Johnny

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N2 - 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.

AB - 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.

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