Post-operative urinary retention rates after autofill versus backfill void trial following total laparoscopic hysterectomy: a randomized controlled trial
Study Objective: To compare the rate of post-operative urinary retention (POUR) after total laparoscopic hysterectomy (TLH) using the autofill versus the backfill void trial. Secondary objectives were to compare the time to discharge from the recovery room, rate of post-operative urinary tract infection (UTI), perceived bladder condition, bladder function impact on life, and patient satisfaction. Design: Randomized controlled trial (Canadian Task Force classification I). Setting: Single academic medical center. Patients: Women who underwent TLH by conventional laparoscopy or robotic-assisted laparoscopy for benign non-urogynecologic indications. Interventions: After TLH, participants were randomized to have an autofill void trial (group A) or a backfill void trial (group B). Failure rate, time to discharge, and UTI rate were assessed. Participants completed the patient perception of bladder condition (PPBC) and the incontinence impact questionnaire-short form (IIQ-7) questionnaires. Patient satisfaction was assessed. Multiple regression analysis was performed to determine predictors of POUR. Measurements and Main Results: 82 participants completed the study after randomization: 42 in group A and 40 in group B. There were no statistically significant differences in demographic or perioperative outcomes. Seven participants had POUR in group A (16.7%) and 11 in group B (27.5%) (p = .36). The median time to discharge was 176 minutes for group A [160.5, 255.5] and 218 minutes for group B [180, 265] (p = 0.01). There were no statistically significant differences in rate of post-operative UTI (p = 1.00), PPBC scores (p = 0.24), IIQ-7 scores (p = 0.23), and patient satisfaction scores (p = 0.26). A stepwise logistic regression analysis demonstrated that pre-operative consumption of progesterone and non-same-day discharge may be weak predictors of POUR (p = .059 and p = .058, respectively). Conclusion: Autofill and backfill void trials result in a comparable rate of POUR with the autofill void trial resulting in faster same-day discharge.