Does Bladder Instillation Reduce Time to Discharge After Sling Surgery

Urinary stress incontinence affects 4-35% of women. Due to the large economic impact and
prevalence of the disease, urinary incontinence is a significant public health issue. With
rising healthcare costs it has become increasingly important to manage patient care in the
most cost-efficient manner. Considering the increasing number of women undergoing
mid-urethral sling procedures, it is imperative that perioperative care is streamlined in
order to minimize cost. The Cedars-Sinai Center for Continence and Women's Pelvic Health
instituted a new practice pattern that enables patients to complete a voiding trial sooner
after surgery compared to previous practice patterns thus allowing patients to be discharged
earlier and ultimately decreasing cost. The purpose of this study is to compare the previous
voiding trial practice (emptying the bladder at the end of surgery) versus the newly
instituted practice (filling with bladder with 250cc) and perform a cost benefit analysis to
determine if there is a significant decrease in recovery and discharge time. Both of these
practices fall under the standard-of-care. However, of the several standard-of-care
procedures, none have been tested for superiority. To date there are no randomized control
trials that address this issue in female mid-urethral sling surgery.

Boccola et al showed in a study of 60 men who had undergone transurethral resection of the
prostate (TURP) that by instilling the bladder with 300-500cc of warm saline the time to void
was significantly decreased compared to standard indwelling catheter removal. It was also
shown that the bladder instillation group had a significantly shorter time to discharge. The
study suggested that given the significant decrease in time in recovery, this would be an
ideal practice for many other outpatient procedures. Willson, et al, in another randomized
trial of 75 men who underwent TURP, found that bladder infusion allowed early decision-making
for discharge on the second postoperative day. Finally, McAchran and Goldman found that when
patients were managed using a fast-track regimen in the outpatient setting after mid-urethral
sling procedures the median time from the recovery area to discharge was less than 3 hours.

For our study, if a significant decrease in the time to discharge with the newly instituted
practice pattern is demonstrated, then this practice can be adopted by other institutions and
become the new standard of care to help decrease both cost and patient time in the hospital.

Inclusion Criteria:

1. Female

2. Age 18 years or older

3. History of stress urinary incontinence

4. Scheduled for outpatient mid-urethral sling procedure, any approach

Exclusion Criteria:

1. Age less than 18 years

2. Pregnancy

3. Inability to give informed consent

4. History of urinary retention