A Systematic Review of Randomized Trials Investigating Methods of Postoperative Void Trials Following Benign Gynecologic and Urogynecologic Surgeries.

Abstract

OBJECTIVE\nTo perform a systematic review of randomized trials (RCT) studying postoperative void trials (VT) following gynecologic and urogynecologic surgery to investigate 1) the optimal postoperative VT methodology and 2) the optimal time after surgery to perform a VT.\n\n\nDATA SOURCES\nPubMed, Embase (Elsevier), the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov.\n\n\nMETHOD OF STUDY SELECTION\nWe systematically searched the above data sources from inception through November 22, 2019 using a combination of subject headings and keywords for three concepts: gynecological surgery (prolapse, benign gynecologic, and incontinence surgery), postoperative period, and voiding. We identified any RCT in English that studied VT methodology or timing in patients undergoing benign gynecologic or urogynecologic surgery. Discrepancies were adjudicated by a third reviewer. We followed standard systematic review methodology and used the Jadad scoring system to assess bias. Extracted study outcomes included: proportion discharged home with catheter, proportion VT failure, surgery for retention, retention after initial VT, postoperative calls and visits, time in PACU, time to discharge, time to spontaneous void, duration of catheterization, patient and provider burden and urinary tract infection (UTI).\n\n\nTABULATION, INTEGRATION & RESULTS\nWe double screened 618 abstracts and clinical trial descriptions, assessed 56 full text articles and ultimately included 21 RCTs. Evidence was low to moderate quality overall.\n\n\nSTUDIES WERE DIVIDED INTO TWO CATEGORIES\nVT methodology (10 studies) and VT timing (11 studies). VT methodology included backfill-assisted (in OR vs PACU), autofill, and force of stream (FoS) studies. One RCT compared backfill-assisted with and without postvoid residual volume (PVR) check. Outcomes were similar for all VT methods, except backfill-assisted decreased time to spontaneous void compared to autofill. In the VT timing category, earlier VT performance correlated with a shorter time to discharge, time to spontaneous void, duration of catheterization, and lower patient burden and UTI rate, but had higher rate of retention after initial VT. There was no difference between earlier versus later VT timing for proportion discharged home with catheter or rate of VT failure. No studies reported outcomes of provider burden or postoperative calls.\n\n\nCONCLUSION\nIn comparing VT methodology, VT by backfill-assisted (in OR vs PACU, +/- PVR), autofill, and FoS resulted in similar outcomes with no one method being superior. Performing VT at an earlier postoperative time point results in shorter time to discharge and spontaneous void, shorter duration of catheterization, lower patient burden, and lower UTI risk, but may increase risk of retention after initial VT.