Sassani Jessica C, Stork Abby, Ruppert Kristine, Bradley Megan S
Division of Urogynecology, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh Medical Center, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA, 1528, USA.
Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Int Urogynecol J. 2020 Jul;31(7):1401-1407. doi: 10.1007/s00192-019-03974-1. Epub 2019 May 23.
Post-operative urinary retention is a common problem affecting close to half of all women undergoing pelvic reconstructive surgery. This was an exploratory analysis that was aimed at identifying factors associated with an inability to learn clean intermittent self-catheterization (CISC) after a failed post-operative retrograde voiding trial (RGVT).
We performed a retrospective case-control study of women who underwent pelvic organ prolapse or urinary incontinence surgery within a single division from 2016 to 2018. We compared women who could learn CISC with those unable to learn and discharged home with an indwelling catheter (IC). Analyses were carried out using Fisher's exact test, the Mann-Whitney U test, the Chi-squared test, and the t test with logistic regression.
Of the 202 women who failed their RGVT, 134 (66.3%) were able to learn CISC and 68 (33.7%) were not. Older age, urinary incontinence, diabetes and colpectomy/colpocleisis were associated with an inability to learn CISC (p < 0.05). Women with an IC were more likely to have an office visit related to catheter care (65.7% vs 5.2%, p < 0.001). A UTI within 30 days of surgery was more common with CISC (16.4% vs 6.0%, p = 0.037). In a multivariate logistic regression model, each increasing year of age was associated with a 1.036-fold decrease in the ability to learn CISC (aOR 1.036, 95% CI 1.002-1.071; p = 0.04).
Increasing age was the only variable identified on multivariate logistic regression as a risk factor for failure to learn CISC. Further studies are needed to identify barriers to learning post-operative self-catheterization.
术后尿潴留是一个常见问题，影响着近一半接受盆腔重建手术的女性。这是一项探索性分析，旨在确定与术后逆行排尿试验（RGVT）失败后无法学会清洁间歇性自我导尿（CISC）相关的因素。
我们对2016年至2018年在单一科室接受盆腔器官脱垂或尿失禁手术的女性进行了一项回顾性病例对照研究。我们将能够学会CISC的女性与无法学会并带着留置导管（IC）出院回家的女性进行了比较。使用Fisher精确检验、Mann-Whitney U检验、卡方检验和逻辑回归的t检验进行分析。
在202例RGVT失败的女性中，134例（66.3%）能够学会CISC，68例（33.7%）不能学会。年龄较大、尿失禁、糖尿病和阴道切除术/阴道闭合术与无法学会CISC相关（p < 0.05）。使用IC的女性更有可能进行与导管护理相关的门诊就诊（65.7%对5.2%，p < 0.001）。术后30天内发生尿路感染在CISC组更为常见（16.4%对6.0%，p = 0.037）。在多变量逻辑回归模型中，年龄每增加一岁，学会CISC的能力就下降1.036倍（调整后比值比1.036，95%置信区间1.002 - 1.071；p = 0.04）。
在多变量逻辑回归中，年龄增加是唯一被确定为无法学会CISC的危险因素的变量。需要进一步研究以确定术后自我导尿学习的障碍。
