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经阴道顶端盆腔器官脱垂手术后的排空试验失败和当天出院:一项回顾性匹配病例对照研究。

Postoperative void trial failure and same-day discharge following apical pelvic organ prolapse surgery: a retrospective matched case-control study.

机构信息

OB/GYN & Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.

出版信息

Int Urogynecol J. 2023 Jun;34(6):1227-1233. doi: 10.1007/s00192-022-05332-0. Epub 2022 Aug 31.

DOI:10.1007/s00192-022-05332-0
PMID:36044062
Abstract

INTRODUCTION AND HYPOTHESIS

Robust data comparing the timing of voiding trials following prolapse surgery are lacking. Filling in these knowledge gaps would be helpful in counseling patients preoperatively about the concerns regarding same-day discharge. We aimed to compare the rate of a failed void trial after apical pelvic organ prolapse (POP) repair between patients who were discharged on the day of surgery versus those discharged on postoperative day 1.

METHODS

This was a retrospective matched case-control study of women who underwent either a laparoscopic/robotic or transvaginal apical POP surgery with or without concurrent hysterectomy. Patients who were discharged on postoperative day 0 (POD0) were identified as cases and matched to control patients discharged on postoperative day 1 (POD1). Patients were matched 1:1 based on age and surgical approach.

RESULTS

A total of 59 patients in each group met the inclusion criteria. Of the entire cohort, 34 (28.8%) patients failed their void trial, with no statistically significant difference between those who were discharged on POD0 versus POD1 (33.9% vs 23.7%, p=0.47). Patients who were discharged on POD0 were more likely to be diagnosed with a urinary tract infection (22.0% vs 8.4%, p=0.041) during the postoperative period.

CONCLUSIONS

In patients undergoing surgery for apical prolapse, there was no difference in the rate of void trial failure in those who had a catheter removal on the day of surgery compared with those who experienced removal the following day.

摘要

引言与假设

缺乏关于脱垂手术后排尿试验时间的有力数据。填补这些知识空白将有助于在术前向患者咨询关于当天出院的担忧。我们旨在比较接受经阴道或腹腔镜/机器人阴道前位(POP)修复术的患者在手术当天出院与术后第一天出院的患者在排空试验失败率。

方法

这是一项回顾性病例对照研究,纳入了接受经阴道或腹腔镜/机器人阴道前位 POP 手术治疗的患者,其中包括或不包括同期子宫切除术。术后第 0 天(POD0)出院的患者被确定为病例,并与术后第 1 天(POD1)出院的对照患者相匹配。根据年龄和手术方式,对患者进行 1:1 匹配。

结果

共有 59 例患者符合纳入标准。在整个队列中,有 34 例(28.8%)患者排空试验失败,POD0 与 POD1 出院的患者之间无统计学差异(33.9%与 23.7%,p=0.47)。POD0 出院的患者术后更有可能被诊断为尿路感染(22.0%与 8.4%,p=0.041)。

结论

在接受阴道前位脱垂手术的患者中,在手术当天拔除导尿管与次日拔除导尿管的患者之间,排空试验失败的发生率无差异。

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本文引用的文献

1
Wide Variation in Post-Void Residual Management after Urogynecologic Surgery: A Survey of Urogynecologists' Practices.妇科泌尿手术后残余尿量管理的广泛差异:妇科泌尿医生实践调查
J Clin Med. 2021 May 1;10(9):1946. doi: 10.3390/jcm10091946.
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Postoperative urinary retention after pelvic organ prolapse surgery: influence of peri-operative factors and trial of void protocol.盆腔器官脱垂手术后的术后尿潴留:围手术期因素的影响和排尿试验方案。
BMC Womens Health. 2021 May 11;21(1):195. doi: 10.1186/s12905-021-01330-4.
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When to Remove the Indwelling Catheter After Minimally Invasive Sacrocolpopexy? CARESS (CAtheter REmoval after Sacrocolpopexy Surgery).
微创骶骨阴道固定术后何时拔除留置导管?CARESS(骶骨阴道固定术后导管拔除)研究。
Female Pelvic Med Reconstr Surg. 2020 Feb;26(2):120-127. doi: 10.1097/SPV.0000000000000826.
4
Subjective versus objective determination of bladder emptying following urogynecological surgery: "do you feel that you completely emptied your bladder?".尿妇科手术后膀胱排空的主观与客观评估:“您是否觉得已经完全排空膀胱?”
Int Urogynecol J. 2020 Sep;31(9):1899-1905. doi: 10.1007/s00192-019-04216-0. Epub 2020 Jan 27.
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Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse.盆腔器官脱垂的流行病学、诊断和病理生理学的叙述性综述。
Int Braz J Urol. 2020 Jan-Feb;46(1):5-14. doi: 10.1590/S1677-5538.IBJU.2018.0581.
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30-Day unanticipated healthcare encounters after prolapse surgery: impact of same day discharge.脱垂手术后 30 天内意外的医疗保健遭遇:当日出院的影响。
Am J Obstet Gynecol. 2020 May;222(5):482.e1-482.e8. doi: 10.1016/j.ajog.2019.11.1249. Epub 2019 Nov 13.
7
Patient Discharge without an Order to Void in the Outpatient Gynecologic Surgery Setting.门诊妇科手术环境下患者未下排尿医嘱而出院。
J Minim Invasive Gynecol. 2020 Jul-Aug;27(5):1059-1062. doi: 10.1016/j.jmig.2019.09.770. Epub 2019 Sep 11.
8
Patient perceptions of same-day discharge after minimally invasive gynecologic and pelvic reconstructive surgery.患者对微创妇科和盆腔重建手术后当天出院的看法。
Am J Obstet Gynecol. 2019 Dec;221(6):621.e1-621.e7. doi: 10.1016/j.ajog.2019.06.046. Epub 2019 Jun 27.
9
Enhanced Recovery after Surgery in Gynecology: A Review of the Literature.妇科手术后加速康复:文献综述。
J Minim Invasive Gynecol. 2019 Feb;26(2):327-343. doi: 10.1016/j.jmig.2018.12.010. Epub 2018 Dec 20.
10
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Int Urogynecol J. 2018 Aug;29(8):1203-1212. doi: 10.1007/s00192-018-3641-3. Epub 2018 Mar 29.