Abstract
Introduction and hypothesis
We tested the hypothesis that women can subjectively determine if they have emptied their bladder after a spontaneous voiding attempt following urogynecological surgery to rule out post-operative urinary retention as determined by a voiding trial.
Methods
This is a prospective observational study of women undergoing urogynecological surgery at two academic institutions from June 2016 to March 2019. Following surgery, subjects underwent a voiding trial followed by measurement of the PVR via ultrasound bladder scan or straight catheterization. A successful voiding trial was defined as a PVR of ≤150 ml. Subjects were queried about their subjective sensation of bladder emptying; “Do you feel that you completely emptied your bladder?” Their responses were either “Yes”, “No” or “I don’t know”. Their subjective responses were correlated with the voiding trial results using a Chi-squared analysis for sensitivity, specificity, and positive (PPV) and negative predictive values (NPV).
Results
A total of 266 subjects were included in the final evaluation. The screening subjective question had a sensitivity of 85.7% (CI 71.46 to 94.57%), a specificity of 91.5% (CI 87.01 to 94.79%), a PPV of 65.4% (CI 54.78 to 74.77%), and an NPV of 97.14% (CI 94.18 to 98.62%) to detect a failed voiding trial.
Conclusions
The NPV of the subjective question regarding bladder emptying in the post-operative urogynecological setting is high at >97%, suggesting that it might be reasonable to forgo a formal voiding trial in patients who subjectively feel that they have emptied their bladder.
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References
Adelowo AO, Hacker MR, Merport Modest A, et al. Do symptoms of voiding dysfunction predict urinary retention? Female Pelvic Med Reconstr Surg. 2012;18:344–7.
Alas A, Hidalgo R, Espaillat L, et al. Does spinal anesthesia lead to postoperative urinary retention in same-day urogynecology surgery? A retrospective review. Int Urogynecol J. 2019;30:1283–9.
Geller EJ. Prevention and management of postoperative urinary retention after urogynecologic surgery. Int J Womens Health. 2014;6:829–38.
Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005;193:103–13.
Shumaker SA, Wyman JF, Uebersax JS, et al. Health-related quality of life measures for women with urinary incontinence: the incontinence impact questionnaire and the urogenital distress inventory. Continence program in women (CPW) research group. Qual Life Res. 1994;3:291–306.
Baldini G, Bagry H, Aprikian A, et al. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology. 2009;110:1139–57.
Smithling KR, Mwesigwa PJ, Siddiquie MM, et al. (2018) Risk factors for incomplete bladder emptying after prolapse repairs and slings. Female Pelvic Med Reconstr Surg. 2018. https://doi.org/10.1097/SPV.0000000000000595.
Hakvoort RA, Dijkgraaf MG, Burger MP, et al. Predicting short-term urinary retention after vaginal prolapse surgery. Neurourol Urodyn. 2009;28:225–8.
Sokol AI, Jelovsek JE, Walters MD, et al. Incidence and predictors of prolonged urinary retention after TVT with and without concurrent prolapse surgery. Am J Obstet Gynecol. 2005;192:1537–43.
Carter-Brooks CM, Zyczynski HM, Moalli PA, et al. Early catheter removal after pelvic floor reconstructive surgery: a randomized trial. Int Urogynecol J. 2018;29:1203–12.
Darrah DM, Griebling TL, Silverstein JH. Postoperative urinary retention. Anesthesiol Clin. 2009;27:465–84.
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KK: project development, data collection and analysis, manuscript writing; AE: protocol and project development, data collection, manuscript editing; SS: protocol and project development, data collection, manuscript editing; VG: protocol supervision data collection, database development; LM: data collection, database construction; DC: data collection; MN: data collection.
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Swift: local PI research Cook Myosite, legal consultant Boston Scientific. The remaining authors claim that they no conflicts of interest.
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Kesty, K., Edenfield, A., Castro, D. et al. Subjective versus objective determination of bladder emptying following urogynecological surgery: “do you feel that you completely emptied your bladder?”. Int Urogynecol J 31, 1899–1905 (2020). https://doi.org/10.1007/s00192-019-04216-0
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DOI: https://doi.org/10.1007/s00192-019-04216-0