Backfill assisted voiding was better than spontaneous voiding for successful bladder emptying after vaginal surgery
R T Foster
Dr R T Foster, Duke University Medical Center, Durham, NC, USA;
Is backfill assisted voiding better than spontaneous voiding for evaluating bladder functioning after outpatient transvaginal surgery?
randomised, controlled, pilot trial.
up to 6 weeks after surgery.
urogynaecology or female urology outpatient clinic in the USA.
60 women who were 18–80 years of age and had outpatient vaginal surgery. Exclusion criteria were pregnancy and incarceration.
30 patients were allocated to backfill assisted voiding and taken to the postoperative anaesthesia care unit (PACU) with an indwelling catheter. After anaesthesia recovery, the bladder was filled retrograde with room-temperature, sterile normal saline until the patient had a strong urge to void or the instilled volume was 300 ml. The catheter was then removed, and the patient was allowed to void. 30 patients allocated to spontaneous voiding were taken to the PACU without a catheter and, after anaesthesia recovery, were prompted to void when they sensed a full bladder. Patients who failed a voiding trial were discharged home with an indwelling catheter or to perform clean, intermittent self-catheterisation.
included time in PACU, voiding technique success (voided volume ⩾200 ml with post-void residual urine less than amount voided), and patient satisfaction (single question). 60 patients were required to detect a 30-minute difference for time in PACU (80% power).
92% (mean age 57 y) were included in the analysis.
After vaginal surgery, the backfill assisted voiding group was more likely to void successfully before discharge than the spontaneous voiding group (table). Groups did not differ for satisfaction with the voiding technique used (table) or mean time in the PACU (200 v 227 min, p = 0.08).
After transvaginal surgery, evaluation of bladder functioning using backfill assisted voiding was better than spontaneous voiding for successful emptying of the bladder before discharge.
Foster RT Sr, Borawski KM, South MM, et al. A randomized, controlled trial evaluating 2 techniques of postoperative bladder testing after transvaginal surgery. Am J Obstet Gynecol 2007;197:627.e1–4.
Voiding dysfunction after gynaecological surgery is a common problem that has received little attention in the surgical literature. Foster et al conducted a pilot study of techniques to evaluate this condition in a population of ambulatory patients who had transvaginal surgery. Their study is a useful addition to the small, current knowledge base.1 The finding that a backfill assisted voiding trial was more effective than a trial of spontaneous voiding for evaluating postoperative bladder functioning is an important step towards improving the patient experience in this population. The backfill assisted voiding group also spent less time in the PACU. Although this difference was not statistically significant, any decrease in time can have a clinical impact in a department that measures length of stay in minutes.
A strength of the study was the collection of data on patient experiences of pain, discomfort, and satisfaction. Patient perception is important, especially for this type of problem, which surgeons may consider to be of minor importance compared with other serious postoperative complications. Being discharged from hospital with an indwelling Foley catheter or to perform intermittent self-catheterisation can be a distressing experience for patients.
The authors acknowledged several limitations of the study. The sample size was small, and due to the nature of the intervention, blinding of nursing staff and patients was not possible. However, the ability to void after surgery is not likely to be easily influenced or subject to observational bias.
Voiding dysfunction is not limited to outpatient transvaginal surgery, and any intervention that reduces this problem after surgery should be further investigated. Further research should be conducted in a larger, more diverse population.