Active Versus Passive Voiding Protocols After Same-Day Minimally Invasive Hysterectomy.

Abstract

STUDY OBJECTIVE\nTo determine proportion of patients discharged with a urinary catheter after a same-day benign gynecologic minimally invasive hysterectomy (MIH) according to active versus passive voiding protocol. Secondary objectives included assessing post anesthesia care unit (PACU) duration and postoperative urinary retention (POUR) rate ≤2 weeks of discharge.\n\n\nDESIGN\nRetrospective observational cohort study.\n\n\nSETTING\nLarge integrated healthcare system serving ∼40% of Northern California population.\n\n\nPATIENTS\nPatients ≥18 years old, undergoing same-day MIH without urogynecology procedures 2015-2018, were categorized into active or passive voiding trial groups. Active voiding trials were defined as patients arriving in PACU with a catheter, retrograde filling the bladder with 300ml, then allowing for voiding ≥50% within 30 minutes. If unable to void this volume, then discharged with a catheter to be removed within 24 hours. A passive voiding trial involved filling or not filling the bladder prior to PACU arrival without a catheter, then allowing for voiding or performing a straight catheterization if unable to void.\n\n\nINTERVENTIONS\nN/A.\n\n\nMAIN RESULTS\n1644 (83.2%) patients underwent passive voiding trials and 333 (16.8%) active voiding trials. Proportion of patients discharged with a catheter was lower in the passive voiding group than the active voiding group (5.4% versus 10.5%, P=.001). Passive group had shorter mean PACU time than active group (218±86 versus 240±93 minutes, P<.001). Crude POUR rates for the passive and active voiding groups were 1.8% and 3.0%, respectively (P=.16).\n\n\nCONCLUSION\nWithin an integrated healthcare system, patients who underwent passive voiding trials compared to active trials were discharged home from the PACU after shorter duration, a larger proportion were discharged home without a urinary catheter, and there were no differences in POUR rates. Our findings suggest that passive voiding trials can be safely utilized after a benign MIH to reduce hospital duration, optimize healthcare resources, and improve patient experience.