BACKGROUND AND PURPOSE:

• Many centers require a successful bladder voiding trial prior to patient discharge
• Thiel et al. (Obstetrics & Gynecology, 2021) compared postoperative bladder retrofilling to passive filling after outpatient gynecologic surgery to evaluate effects on postoperative outcomes including time to hospital discharge

METHODS:

• Systematic review and meta-analysis
• Inclusion criteria
  • RCTs
  • Studies that compared postoperative bladder retrofilling to passive filling in patients who underwent outpatient gynecological surgery by any approach
• Study design
  • Mean differences and relative risk (RR) were calculated for the meta-analysis
  • Risk of bias was assessed using the Cochrane Risk of Bias Tool
• Primary outcome
  • Time to first void
• Secondary outcomes
  • Time to discharge
  • Postoperative urinary retention
  • Urinary tract infection
  • Patient satisfaction

RESULTS:

• 8 studies | 1173 patients
• Bladder retrofilling in the operating room resulted in a significant decrease in
  • Time to first void
    • Mean difference −33.5 minutes (95% CI, −49.1 to −17.9)
    • 4 studies, 403 patients
  • Time to discharge
    • Mean difference –32.0 minutes (95% CI, −51.5 to −12.6)
    • 9 studies, 1164 patients
• Bladder retrofilling did not shorten time to discharge when performed In the postanesthetic care unit
  • Mean difference –14.8 min (95% CI, −62.6 to 32.9)
  • 3 studies, 258 patients
• After laparoscopic hysterectomy
  • Bladder retrofilling did decrease time to first void
    • Mean difference –26.9 min (95% CI, −37.9 to −15.8)
  • No difference in time to discharge
    • Mean difference –26.0 min (95% CI, −56.5 to 4.5)
    • 5 studies, 657 patients
• There were no differences between the retrofill and passive fill groups for
  • Postoperative urinary retention
    • RR 0.77 (95% CI, 0.45 to 1.30)
    • 5 studies, 910 patients
  • Risk of urinary tract infection
    • RR 0.50 (95% CI, 0.14 to 1.77)
    • 4 studies, 387 patients

CONCLUSION:

• Retrofilling the bladder in the operating room after outpatient gynecological surgery can reduce the time to first successful void trial and time to discharge, with no evidence of adverse events
• The authors state

In an era of increasing emphasis on health care resource efficiency, this inexpensive and straightforward intervention should be considered for inclusion in outpatient surgical recovery protocols

Although time to discharge was not reduced, clinicians should not discount postoperative bladder filling for outpatient hysterectomy because it is a safe, simple intervention that facilitates a quicker time to first void

Learn More – Primary Sources:

Retrograde Bladder Filling After Outpatient Gynecologic Surgery: A Systematic Review and Meta-analysis

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