Fernandez-Gonzalez Sergi, Martinez Franco Eva, Martínez-Cumplido Rubén, Molinet Coll Cristina, Ojeda González Funesanta, Gómez Roig Maria Dolores, Amat Tardiu Lluís
BCNatal | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Institut de Recerca Sant Joan de Déu, c/ Passeig Sant Joan de Déu 2, CP 08950, Esplugues de Llobregat, Barcelona, Spain.
Parc Sanitari Sant Joan de Déu, c/ Cami Vell de la Colonia 25, CP: 08830, Sant Boi de Llobregat, Barcelona, Spain.
Int Urogynecol J. 2019 Nov;30(11):1897-1902. doi: 10.1007/s00192-018-3818-9. Epub 2018 Nov 27.
There is a distinct lack of literature on postoperative management after anterior colporrhaphy (AC). Our traditional postoperative protocol consisted of 24 h of indwelling catheterisation followed by 24 h of self-intermittent catheterisation. We hypothesised that a new protocol consisting of only 24 h of indwelling catheterisation might produce better results without additional complications.
From April 2014 to July 2017, all candidates for AC were randomised to catheter removal 24 or 48 h after surgery. The primary outcome was the postoperative urinary retention (POUR) rate. Secondary outcomes included: asymptomatic bacteriuria (AB), urinary tract infection (UTI) and postoperative pain after 24 h.
A total of 79 patients were recruited. Thirty-seven and 40 patients were randomised to follow the 48-h protocol and the 24-h protocol respectively. There were no significant differences in relation to the POUR rate: 3 patients (8.1%) vs 1 (2.5%) in the 48-h vs the 24-h group respectively (p = 0.346). The UTI rate was 2 (8.1%) vs 0 patients respectively (p = 0.139) and the postoperative AB rate was 3 (9.1%) vs 0 patients (p = 0.106). In the postoperative pain evaluation, the visual analogue scale score was significantly higher in the 48 h group (0.35 vs 0.13, p = 0.02).
According to our results, reducing the catheterisation from 48 to 24 h after AC does not increase the risk of POUR and decreases the rate of UTI, AB and postoperative pain. This new postoperative management protocol of pelvic floor surgery would improve postoperative outcomes and shorten the stay in hospital.
关于前盆腔修补术（AC）术后管理的文献明显匮乏。我们传统的术后方案包括留置导尿管24小时，随后进行24小时的自行间歇性导尿。我们假设仅留置导尿管24小时的新方案可能会产生更好的效果且无额外并发症。
2014年4月至2017年7月，所有AC手术候选患者被随机分为术后24小时或48小时拔除导尿管组。主要结局是术后尿潴留（POUR）发生率。次要结局包括：无症状菌尿（AB）、尿路感染（UTI）以及术后24小时的疼痛情况。
共招募了79例患者。分别有37例和40例患者被随机分配至遵循48小时方案和24小时方案组。POUR发生率无显著差异：48小时组为3例（8.1%），24小时组为1例（2.5%）（p = 0.346）。UTI发生率分别为2例（8.1%）和0例（p = 0.139），术后AB发生率分别为3例（9.1%）和0例（p = 0.106）。在术后疼痛评估中，48小时组的视觉模拟评分显著更高（0.35对0.13，p = 0.02）。
根据我们的结果，AC术后将导尿时间从48小时减至24小时不会增加POUR风险，且会降低UTI、AB发生率以及术后疼痛程度。这种新的盆底手术术后管理方案将改善术后结局并缩短住院时间。
