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Passive vs Active Voiding Trial Techniques Post Robotic Pelvic Reconstructive Surgery

Passive vs Active Voiding Trial Techniques Post Robotic Pelvic Reconstructive Surgery

Presenting Author(s)

Salma Attai, BS

Medical Student
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
Buffalo, New York, United States

Co-Author(s)

IA

Ismail Attuwaybi, BS

Student
University at Buffalo
Buffalo, New York, United States
Janine A. Meurer, BS (she/her/hers)

Medical Student
Jacobs School of Medicine and Biomedical Sciences
Buffalo, New York, United States
Alyssa N. Sheedy, BS (she/her/hers)

Medical Student
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
Clarence, New York, United States
AE

Abeer Eddib, MD

Urogynecologist
Kaleida Health
Getzville, New York, United States

Objectives: Acute postoperative urinary retention (POUR) is a frequent occurrence after urogynecologic procedures and can result in increased patient discomfort, inconvenience, and need for prolonged catheterization. Additionally, POUR can result in adverse outcomes and an increase in healthcare related costs. There are multiple ways to evaluate a patient for the risk of POUR with no standardization of technique. We aim to compare the outcomes of an active voiding trial, retrograde fill vs a passive voiding trial, 3rd void post void residual (PVR) in a postoperative setting after robotic sacrocolpopexy (SCP) and sling.

Methods:

Design: Retrospective case control study

Setting: Academic-affiliated community hospital

Patients or Participants: All patients (N=1260) undergoing robotic-assisted sacrocolpopexy with transobturator midurethral sling placement by a single urogynecologist at a single institution between January 2012 and March 2023 were evaluated for the impact of the type of voiding trial on perioperative outcomes.

Interventions: Patients were grouped to cases (3rd void PVR) (N=1114) and controls (retrograde voiding trial) (N=146). Perioperative outcomes were compared and evaluated between the two groups.

Results: Measurements and Main

Results: The demographics between the cases (3rd void PVR) and controls (retrograde voiding trial) were similar except that the cases had slightly more obese patients than the controls (BMI 28.6 vs 27.7, p value< 0.05).

In terms of the concomitant procedures, the 3rd void PVR patients were more likely to have a perineorrhaphy 829 (74.9%) vs 73 (50%) p< 0.05, and less likely to have a hysterectomy 678 (60.9%) vs 112 (76.7%), p< 0.05. The cases also had a longer procedure time 110 [80;141] vs 91 [57;128], p< 0.05.

The primary outcome of pain between the 3rd void PVR group and the retrograde voiding trial group showed they had a statistically significant difference in total pain MME (Morphine milligram equivalents) during admission. The 3rd void PVR group had an MME of 15 [4.00;27.4] vs 8 [1.5;19] in the retrograde trial group, OR (odds ratio) 0.97 [0.96;0.99], p< 0.001. The secondary outcome of voiding trial success was that the 3rd void PVR group also had more failed postoperative voiding trials 464 (41.7%) vs 35 (24%) or 0.55 [0.35;0.84], p < 0.001. The mean PVR value in the cases 163 (56.5;264) was higher than the controls 130 (55;193), p< 0.01.

Conclusions:

Conclusion: There is increased total pain MME and lower voiding trial success in the 3rd void PVR group, however since there are significant differences among the groups such as longer procedure times, higher perineorrhaphy rates and less hysterectomy rates in the 3rd void PVR group further investigation is needed to confirm these findings and determine the impact of such variables on the outcomes.