Assessment of Voiding After Sling
| Status: | Recruiting |
|---|---|
| Conditions: | Urology |
| Therapuetic Areas: | Nephrology / Urology |
| Healthy: | No |
| Age Range: | 18 - 81 |
| Updated: | 3/1/2014 |
| Start Date: | April 2011 |
| Contact: | Geetha Krishnan, RN |
| Email: | krishng@ccf.org |
| Phone: | 216-445-8090 |
Assessment of Voiding After Sling (AVAS): A Randomized Trial of Two Methods of Post-operative Catheter Management After Midurethral Sling for Female Stress Urinary Incontinence
The purpose of this study is to compare the incidence of catheterization from discharge to 6
weeks postoperatively when using two methods of post-operative voiding evaluation after a
mid-urethral sling procedure. The investigators' results may lead to a decreased use of
indwelling catheters and their associated morbidity after outpatient sling surgery.
weeks postoperatively when using two methods of post-operative voiding evaluation after a
mid-urethral sling procedure. The investigators' results may lead to a decreased use of
indwelling catheters and their associated morbidity after outpatient sling surgery.
Minimally invasive slings have demonstrated similar efficacy to earlier abdominal
anti-incontinence procedures, but offer the benefit of shorter operating times, less voiding
dysfunction, lower morbidity and are usually done as an outpatient procedure. Despite the
advantages, about 35% of patients are discharged home with indwelling catheters. Indwelling
catheters are bothersome for patients, costly to the healthcare system and are a source of
significant morbidity. The challenge for pelvic surgeons performing anti-incontinence
procedures is avoiding postoperative urinary retention while minimizing the use of catheters
and their associated risks. A commonly described backfill-assisted voiding trial is used as
a means of evaluating bladder function postoperatively. This method uses a low post-void
residual as a specific criterion for discharge without a catheter. However, the validity of
this method has never been critically evaluated. Our recent observational study suggests
that patients may be safely discharged without a catheter after a midurethral sling
procedure based on their subjective assessment of the force of stream. Our proposed study
expands on this pilot data using a randomized trial to evaluate two methods of
post-operative voiding evaluation. The results may lead to a decreased use of indwelling
catheters and their associated morbidity after outpatient sling surgery.
anti-incontinence procedures, but offer the benefit of shorter operating times, less voiding
dysfunction, lower morbidity and are usually done as an outpatient procedure. Despite the
advantages, about 35% of patients are discharged home with indwelling catheters. Indwelling
catheters are bothersome for patients, costly to the healthcare system and are a source of
significant morbidity. The challenge for pelvic surgeons performing anti-incontinence
procedures is avoiding postoperative urinary retention while minimizing the use of catheters
and their associated risks. A commonly described backfill-assisted voiding trial is used as
a means of evaluating bladder function postoperatively. This method uses a low post-void
residual as a specific criterion for discharge without a catheter. However, the validity of
this method has never been critically evaluated. Our recent observational study suggests
that patients may be safely discharged without a catheter after a midurethral sling
procedure based on their subjective assessment of the force of stream. Our proposed study
expands on this pilot data using a randomized trial to evaluate two methods of
post-operative voiding evaluation. The results may lead to a decreased use of indwelling
catheters and their associated morbidity after outpatient sling surgery.
Enrollment:
All patients,18-81 year old, undergoing an outpatient midurethral sling surgery will be
screened for participation in the study at the preoperative visit.
Exclusion:
1. Women undergoing concomitant urinary tract or pelvic reconstructive procedures
2. Women with pelvic organ prolapse beyond the hymen
3. Women who have undergone a different or same procedure for urinary incontinence in
the past
4. Women with neurological conditions, such as multiple sclerosis, spinal cord
injury/pathology
5. Cases complicated by a cystotomy or other complication necessitating postoperative
catheterization
6. Non-English speakers
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2
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