Predictors of Postoperative Voiding Trial Performance in Patients Undergoing Urogynecologic Pelvic Floor Repair without Concurrent Incontinence Procedures

We use postoperative voiding trials to identify patients at risk of urinary retention after urogynecologic procedures. However, voiding trials are associated with lower patient satisfaction and may be unnecessary in low-risk patients. Our aim was to identify predictors of postoperative voiding trial failure after urogynecologic pelvic floor repair without concurrent incontinence procedures to better identify low-risk patients in whom postoperative voiding trials may be eliminated. We conducted a retrospective cohort study of women who underwent urogynecologic pelvic floor repair without concurrent incontinence procedures at two institutions from November 1, 2011 through July 13, 2013. We abstracted demographic and clinical data from medical records. The primary outcome was postoperative voiding trial failure as defined by discharge with catheterization. Descriptive data are presented as mean + standard deviation or n (%). We used multivariable logistic regression to identify risk factors for postoperative voiding trial failure and to calculate the odds ratio (OR) and 95% confidence interval (CI). Of the 371 women who met eligibility criteria, 57 (15.4%) failed the postoperative voiding trial. Women who failed the voiding trial tended to be older (64.3 + 12.4 vs 59.5 + 12.4 years), were less likely to be white (73.7% vs 86.6%; p for race = 0.04) and were less likely to undergo 1 to 2 procedures (26.8% vs 8.8%; p = 0.002) than women who did not fail the voiding trial. The two groups were similar with regard to body mass index, smoking, parity, sexual activity, and having a prior urogynecologic procedure (all p > 0.32). Multivariable regression demonstrated that significant predictors of voiding trial failure included being black (OR = 6.19; 95% CI = 1.46-26.3) or Hispanic race (OR = 5.98; 95% CI = 1.16-30.75) as compared with being white race, undergoing anterior colporrhaphy (OR = 2.62; 95% CI = 1.04-6.57), or undergoing 3 to 4 concurrent procedures as compared to only 1 to 2 procedures (OR = 3.20; 95% CI = 1.04-6.57). Although not statistically significant, patients who had a total vaginal hysterectomy (OR = 3.54; 95% CI = 0.98-12.85) and those who had 5 to 7 concurrent procedures as compared to 1 to 2 procedures (OR = 3.98; 95% CI = 0.88-17.99) were also more likely to fail the voiding trial. Finally, for each 100 mL increase in preoperative post-void residual volume, the risk of voiding trial failure increased by 67% (OR = 1.67; 95% CI = 1.13-2.48). The risk of being discharged home with a catheter after pelvic floor repair was associated with being black or Hispanic and having an anterior colporrhaphy, a higher number of concurrent procedures, and a higher preoperative post-void residual volume. Our results suggest that patients without these characteristics are at a lower risk of voiding trial failure, and therefore, elimination of postoperative voiding trials warrants further investigation.