Optimal Day to Repeat a Postoperative Voiding Trial After Prolapse Surgery

Objectives: To determine the optimal postoperative day following prolapse surgery to repeat a voiding trial after a patient fails an initial voiding trial on postoperative day (POD) 0 or 1.

Methods: This was a retrospective study of patients undergoing prolapse surgery with or without concurrent stress urinary incontinence surgery at a single institution. Consecutive charts were reviewed from January 2021-January 2023. Patients were included in the analysis if they failed an initial voiding trial postoperatively. The voiding trial protocol is to backfill the bladder with 300 cc normal saline and remove the catheter. A successful voiding trial is considered emptying at least 150 cc. Relevant demographic and medical characteristics of patients were recorded. The postoperative day of the first successful voiding trial was recorded. A cumulative daily success rate is calculated along with 95% confidence intervals for each POD. Sample size calculations indicate enrolling 83 patients would provide 80% power when testing against an 80% pass rate on POD 4, assuming the true rate is 90%.

Results: Of 1,224 records reviewed, 137 subjects failed an initial voiding trial and were included. Mean age was 63.4 (SD 12.3) years, body mass index 28.5 (SD 5.2) cm/m2, and vaginal parity 2.6 (SD 1.5). Fifty three (37%) patients received a concurrent mid-urethral sling. The average length of surgery was 227 (SD 70.2) minutes. Nine (7%) patients had diabetes, 9 (7%) identified as a non- white race, 9 (7%) were current smokers, and 6 (4%) developed a postoperative urinary tract infection (UTI) within six weeks of surgery.
The cumulative percent of successful voiding trials by day 4 is 87.5% (95% CI 80.7%-92.6%) (Table 1). The cumulative percent of successful voiding trials by days 3 or 5 did not reach statistical significance testing against null rates of 70% and 90%, respectively. The cumulative percent of successful voiding by day 6 is 96.3% (CI: 91.6%-98.8%).
Table 1 shows the number of patients who repeated a voiding trial on each day, the percent of successful voiding trials each day, and the 95% confidence interval.

Conclusions: Over 85% of patients passed a repeat voiding trial by POD 4, and over 95% by day 6. The optimal time to repeat a voiding trial after prolapse surgery with or without incontinence surgery is between postoperative days 4-6.