Retrograde bladder filling after laparoscopic gynecologic surgery: a double-blind randomized controlled trial

Zakhari, Andrew; Paek, Wusun; Chan, Wilson; Edwards, Darl; Matelski, John; Solnik, M. Jonathon; Murji, Ally

Objective To evaluate whether retrofilling the bladder upon completion of elective laparoscopic gynecologic surgery for benign indications has an effect on the timing of the first post-operative void and timing of discharge from hospital. Design Double-blind randomized controlled trial Setting Single academic surgical day hospital Patients Patients undergoing outpatient laparoscopic gynecologic surgery, excluding hysterectomy or pelvic reconstructive surgery. Interventions Upon completion of surgery, patients were randomized to either retrograde filling of the bladder with 200 mL of saline prior to catheter removal or standard care (immediate catheter removal). Patients and PACU nurses (outcome assessors) were both blinded. Measurements The primary outcome was the time to first void. Secondary outcomes were time to hospital discharge, post-operative urinary tract infection and patient satisfaction. Main Results Over a 3 month period, 47 patients were approached on the day of surgery, 42 consented and were randomized (21 to intervention and 21 to control). There were no significant differences in baseline demographics between groups. The median time to first void was significantly shorter for patients in the intervention arm compared to controls (104 ± 75min vs 162 ± 76min, p<0.001). Retrofilled patients were discharged faster from PACU compared to controls (155.0 ± 74min vs 227 ± 58min, p=0.001). There were no urinary tract infections in either group and the proportion of satisfied or very satisfied patients was high (93.8% vs. 88.2%, p=0.512). Conclusion Retrograde filling the bladder after outpatient laparoscopic gynecologic surgery is a safe, effective method that significantly reduces length of hospital stay.