(Poster 27) Optimizing the Postoperative Voiding Trial: A Randomized Controlled Trial

Objectives: Postoperative voiding dysfunction is a common occurrence following Urogynecologic surgery. While the current literature favors the use of a Retrograde Active voiding trial (RAVT), it does not provide a universally accepted definition of a successful Retrograde Active VT in terms of voided volume. The aim of this study is to examine the two most commonly accepted RAVT voided volumes used to determine a failed voiding trial; (voiding 2/3 of the bladder volume vs. voiding ½ of the retrograde filled bladder volume) to determine the optimal voided volume with the hopes of establishing a standard of care. We hypothesize that patients who void ½ of the retrograde filled volume will have a similar risk of re-catheterization, urinary tract infection, and de novo lower urinary tract symptoms as those required to void 2/3 of the retrograde filled volume but will result in fewer patients discharged with catheterization.

Methods: This is a parallel randomized controlled single site equivalence trial.  This analysis focused on patients undergoing Urogynecologic surgery by a single surgeon between July 2023 and January 2024. Patients were randomized into the control group (Group 1) (200cc voided OR 2/3 of the tolerated retrograde filled volume if unable to tolerate retrograde filling to 300cc) or the test group (Group 0) (150cc voided OR ½ of the retrograde filled volume if unable to tolerate retrograde filling to 300cc). Our primary outcome was the frequency of acute voiding dysfunction defined as failed initial post-op VT requiring transient indwelling catheter placement. Our secondary outcomes included postoperative urinary tract infection, bladder pain/pressure, new onset OAB symptoms, and overall number of patients discharged with transient catheterization or who required early post-op evaluation for acute voiding dysfunction after passing initial VT.

Results: Among 97 women, 48 (49.5%) were randomized into Group 1, and 49 (50.5%) were randomized into Group 0. Using generalized estimating equations adjusting for age, race, BMI, presence of comorbidities (diabetes, HTN, anxiety), tobacco use, surgery/surgical bundle, group 1 was equivalent to group 0 in regards to our primary outcome (OR 0.946, p-value 0.0032). Regarding our secondary outcomes, development of post-operative UTI, bladder pain/pressure, and new onset OAB symptoms were each found to be equivalent between group 1 and group 0. When comparing the number of patients that failed the initial VT with transient catheterization, group 0 had fewer patients discharged with a catheter (8 [16.3%]), group 1 (10 [20.8%]), however, overall were not significantly different (p-value 0.5861.)

Conclusions: With consideration of observed equivalence and accepted risk associated with postoperative catheterization, our findings suggest a successful retrograde active VT should be defined as voiding at least 50% or 150cc of the retrograde filled volume (typically 300cc).