Rate of Postoperative Urinary Retention After Anterior Compartment Prolapse Surgery: a Randomized Controlled Trial Comparing Early Versus Conventional Transurethral Catheter Removal

Purpose To compare the rate of postoperative urinary retention (POUR) after anterior prolapse surgery between early transurethral catheter removal (24 hours postoperatively) and our standard practice (on postoperative day 3)Methods We conducted a randomized controlled trial among patients undergoing anterior compartment prolapse surgery between 2020 and 2021 at a university hospital. Women were randomized into two groups. After removal, if the second void residual urine volume exceeded 150 mL, POUR was diagnosed and intermittent catheterization was performed. The primary outcome was the POUR rate. The secondary outcomes included urinary tract infection, asymptomatic bacteriuria (AB), time to ambulation, time to spontaneous voiding, length of hospitalization, and patient satisfaction.Results Sixty-eight women were enrolled. There were no significant differences in baseline characteristics, intraoperative blood loss, operative time, anesthetic modalities, opioid use, and complications. The overall POUR rate was 29.4%. The POUR rate in the conventional group was 18.2% higher than that in the early-removal group; however, this was not statistically significant. (32.4% vs. 26.5%, RR 0.82; 95% CI: 0.39–1.72). There was no significant difference between groups for postoperative AB rate (14.7 vs. 0%, p=0.053). The early-removal group had shorter lengths of hospital stay (1 day vs. 3 days, p<0.001) and 3.8 hours earlier time to ambulation (p=0.2), without significant differences in postoperative patient satisfaction. Conclusion Among patients undergoing anterior compartment prolapse surgery, early catheter removal was comparable in POUR rate to conventional treatment, with shorter hospitalization. Therefore, early transurethral catheter removal is preferable following anterior compartment prolapse surgery. Clinical trial registration number thaiclinicaltrials.org, TCTR20210309003, 09 March 2021, retrospectively registered.

The Value of Preoperative Urodynamics in Surgery Decision for Pelvic Organ Prolapse Patients with Occult Stress Urinary Incontinence

This retrospective cohort study aims to explore the clinical value of urodynamics in evaluating lower urinary tract function in pelvic organ prolapse (POP) patients, and to investigate the urodynamic characteristics of POP patients with occult stress urinary incontinence (OSUI) in whom moderate or above postoperative SUI eventually occurred after prolapse surgery. The medical records of 626 advanced POP patients who underwent vaginal pelvic reconstructive surgery were analyzed. The patients with anterior compartment prolapse were more susceptible to urodynamic changes than those with apical or posterior compartment prolapse (95.1% vs. 40.15%). The proportion of patients with urodynamic abnormality was increased with prolapse severity (68.8% vs. 78.6%). After 3 months, the incidence of moderate or severe postoperative urinary incontinence in the OSUI patients was 20%, while it is 2.8% in non-OSUI patients. In subgroup analysis of OSUI patients, the urodynamics of patients with moderate or above postoperative urinary leakage showed significantly lower Valsalva leak point pressure (VLPP), maximum urethral closure pressure (MUCP), maximal bladder volume (MBV) and maximum urine flow rate (MUFR). For POP patients with OSUI, anti-incontinence surgery is only recommended for whom with lower VLPP, MUCP, MBV and MUFR to avoid the risk and costs of secondary surgery or overtreatment.

Ventral Rectopexy

Rectal prolapse is a debilitating condition that often results in impaired quality of life. Posterior compartment defects including rectal prolapse and rectal intussusception are often associated with middle and anterior compartment prolapse and require a multicompartment approach to treatment. In recent years, ventral rectopexy, with or without sacrocolpopexy for combined middle compartment prolapse, has emerged as a safe and effective method of treatment for rectal prolapse. In this article, we aim to review the etiology of rectal prolapse and intussusception, describe the indications and workup for surgery, discuss technical aspects of ventral rectopexy alone and in combination with sacrocolpopexy, review potential surgical complications, and describe the reported outcomes of the surgery.