Predictors for Voiding Trial Failure after Minimally Invasive Sacrocolpopexy

Abstract

Introduction: Voiding trials are often used after reconstructive pelvic surgery to ensure adequate post-op voiding. 2.5-24% of patients fail these voiding trials requiring catheter replacement and repeat trial at a later date (1). The increased risk of infection attributed to indwelling lines, including urethral catheters, is well recognized and national efforts have been made to decrease their duration of use (2). The preoperative identification of patients likely to fail a voiding trial would allow for selected instruction in self-catheterization techniques and minimize indwelling catheterization. Objective: The objective was to identify predictors for voiding trial failure after minimally-invasive (laparoscopic or robot-assisted) sacrocolpopexy for surgical correction of prolapse in patients who did not undergo a concomitant urinary anti-incontinence procedure. We hypothesized that voiding trial failure would be associated with increasing age, BMI, length of surgery, severity of prolapse, hysterectomy at time of procedure, concomitant vaginal surgery, preoperative history of urinary retention, use of scopolamine patch perioperatively, and preoperative urodynamic testing parameters. Specific urodynamic parameters hypothesized to predict voiding trial failure included high cystometric maximum capacity, elevated post-void residual, high maximum urethral closure pressure, normal desire to void >300ml, low peak flow rate, and detrusor voiding mechanism. Methods: All subjects undergoing minimally-invasive sacrocolpopexy without concomitant anti-incontinence surgery from October 2006 to July 2010 at our institution were included. We collected patient characteristics including basic demographics, medical and surgical history, operative characteristics, and baseline preoperative urodynamic testing. The data was analyzed with logistic regression for continuous variables and Pearson chi-squared test for dichotomous or categorical variables (Stata IC-13). Results: 60 subjects were identified. Of those, 9 subjects (15%) failed a postoperative voiding trial. Concomitant vaginal surgery was significantly associated with failure of trial of void. Participants with concomitant vaginal surgery had a two-fold increase in voiding trial failure, p-value of 0.034. All other variables showed no significant association. Conclusions: The percentage of subjects that failed a voiding trail was comparable to that described in the literature (1). Many factors analyzed in our study, including age, BMI, stage of prolapse, and preoperative urodynamic parameters did not impact voiding trial failure rate. Among participants undergoing minimally-invasive sacrocolpopexy, we found that concomitant vaginal surgery was significantly associated with voiding trial failure.