Predictors for Voiding Trial Failure after Minimally Invasive Sacrocolpopexy

The healthcare industry is increasingly focusing on reducing preventable complications. Iatrogenic complications such as pressure wounds, central line infections and catheter-associated urinary tract infections (CAUTIs) are not only costly, but can lead to potentially life threatening sequelae. It is estimated that each CAUTI costs anywhere from $749-1007, and CAUTIs were among the first selected to the non-payment list by Medicare as of October 2008 [1]. In the field of urogynecology, prolonged catheterization is a reality for many patients, especially in the postoperative setting. Postoperative voiding dysfunction after prolapse surgeries with or without incontinence surgery have been estimated between 22-62% [2-5]. Pelvic organ prolapse affects one in 10 women [6] and approximately 200,000 patients per year undergo a prolapse surgery in the United States [7]. Nearly all patients are evaluated for postoperative voiding dysfunction via a backfill trial of void (TOV). In the era of minimally invasive surgery, patients are leaving the hospital earlier, and are often left to deal with an uncomfortable and cumbersome indwelling catheter – a potential nidus for infection, especially when being cared for by a non-health professional. Intermittent self-catheterization has been shown to be a superior alternative to indwelling urinary catheters, leading to reduced CAUTIs and increased patient satisfaction [8,9]. Instituting this policy universally does require a significant investment in patient education on behalf of the healthcare provider, as a lack of understanding or compliance with self-catheterization can lead to disastrous consequences, including permanent bladder injury secondary to irreversible nerve damage [10]. The ability to riskstratify patients preoperatively, in terms of individual risk for voiding trial failure, could focus patient education regarding selfcatheterization techniques to the highest risk population, more efficiently utilizing healthcare industry resources. There are a paucity of data regarding risk factors for postoperative TOV failure after minimally invasive sacrocolpopexy and, to our knowledge, no studies have focused specifically on preoperative risk factors, available to the healthcare provider at the time of preoperative evaluation, at which time patient education regarding selfcatheterization techniques could be implemented. Volume 3 Issue 2 2015