Department of Urology/Urogynecology, Westchester Medical Center, and New York Medical College School of Medicine, Valhalla, New York.
Obstet Gynecol. 2024 May 1;143(5):633-643. doi: 10.1097/AOG.0000000000005567. Epub 2024 Mar 28.
To compare active with passive voiding trials on the rate of passing a trial of void and discharge rates with catheter in women who have undergone midurethral sling for treatment of stress urinary incontinence (SUI).
MEDLINE, EMBASE, and ClinicalTrials.gov were searched through February 24, 2023.
Our population included women undergoing midurethral sling, with or without anterior or posterior repair, for treatment of SUI. Our two primary outcomes were rate of passing voiding trial and rate of discharge with a catheter. Our secondary outcome was the rate of delayed postoperative urinary retention, when a patient initially passes a trial of void but then subsequently presents in retention.
TABULATION, INTEGRATION, AND RESULTS: Abstracts were doubly screened; full-text articles were doubly screened; and accepted articles were doubly extracted. In single-arm studies evaluating either passive or active voiding trial, random-effects meta-analyses of pooled proportions were used to assess outcomes. Of 3,033 abstracts screened, 238 full-text articles were assessed, and 26 met inclusion criteria. Ten studies including 1,370 patients reported active trial of void. Sixteen studies including 3,643 patients reported passive trial of void. We included five randomized controlled trials, five comparative retrospective studies, five prospective single group studies, and 11 retrospective single group studies. Five of the studies included patients with a concomitant anterior or posterior colporrhaphy. On proportional meta-analysis, the active trial of void group was less likely to pass the voiding trial (81.0%, 95% CI, 0.76-0.87% vs 89.0%, 95% CI, 0.84-0.9%3, P =.029) with high heterogeneity ( I2 =93.0%). Furthermore, there were more discharges with catheter in active trial of void compared with passive trial of void (19.0%, 95% CI, 0.14-0.24% vs 7.0%, 95% CI, 0.05-0.10%, P <.01). The rates of delayed postoperative urinary retention were low and not different between groups (0.6%, 95% CI, 0.00-0.02% vs 0.2%, 95% CI, 0.00-0.01%, P =.366) with low heterogeneity ( I2 =0%). Sling revisions were statistically lower in the active trial of void group (0.5%, 95% CI, 0.00-0.01% vs 1.5%, 95% CI, 0.01-0.02%, P =.035) with low heterogeneity ( I2 =10.4%).
Passive trial of void had higher passing rates and lower discharge with catheter than active trial of void. Rates of most complications were low and similar between both groups, although passive trial of void had higher sling revisions.
PROSPERO, CRD42022341318.
比较主动和被动排尿试验在接受经尿道中段吊带术治疗压力性尿失禁（SUI）的女性中通过试验性排尿和带管出院的比例。
通过 2023 年 2 月 24 日检索 MEDLINE、EMBASE 和 ClinicalTrials.gov。
我们的研究人群包括接受经尿道中段吊带术治疗的女性，无论是否同时进行前或后修补术。我们的两个主要结局是通过排尿试验的比例和带管出院的比例。我们的次要结局是术后延迟性尿潴留的发生率，即患者最初通过了排尿试验，但随后出现了尿潴留。
表格、综合和结果：摘要进行了双重筛选；全文文章进行了双重筛选；并对接受的文章进行了双重提取。在评估被动或主动排尿试验的单臂研究中，使用汇总比例的随机效应荟萃分析来评估结局。在筛选出的 3033 篇摘要中，有 238 篇全文文章进行了评估，有 26 篇符合纳入标准。10 项研究包括 1370 名患者，报告了主动排尿试验。16 项研究包括 3643 名患者，报告了被动排尿试验。我们纳入了 5 项随机对照试验、5 项比较性回顾性研究、5 项前瞻性单组研究和 11 项回顾性单组研究。其中 5 项研究包括同时进行前或后阴道修补术的患者。在比例荟萃分析中，主动排尿试验组更有可能通过排尿试验（81.0%，95%CI，0.76-0.87% vs 89.0%，95%CI，0.84-0.9%3，P=.029），但存在高度异质性（I2=93.0%）。此外，与被动排尿试验相比，主动排尿试验组带管出院的比例更高（19.0%，95%CI，0.14-0.24% vs 7.0%，95%CI，0.05-0.10%，P<.01）。两组术后延迟性尿潴留的发生率均较低且无差异（0.6%，95%CI，0.00-0.02% vs 0.2%，95%CI，0.00-0.01%，P=.366），异质性较低（I2=0%）。主动排尿试验组的吊带修复术发生率较低（0.5%，95%CI，0.00-0.01% vs 1.5%，95%CI，0.01-0.02%，P=.035），但存在高度异质性（I2=10.4%）。
被动排尿试验的通过率较高，带管出院的比例较低，而主动排尿试验则相反。大多数并发症的发生率较低且两组相似，但被动排尿试验的吊带修复术更高。
PROSPERO，CRD42022341318。
