A prospective randomized trial to compare side effects of early versus late removal of Foley’s catheter and vaginal pack following vaginal hysterectomy

Background: There is a controversy about the ideal time for removal of catheter and vaginal pack following vaginal hysterectomy. The present study was undertaken to compare post-operative morbidity in early and late removal of Foley’s catheter and vaginal pack. The aim of this study is to compare post-operative morbidity in early and late removal of Foley’s catheter and vaginal pack following vaginal hysterectomy.Methods: This was a prospective randomized study with n=100 of those women who were undergoing vaginal hysterectomy with or without pelvic floor repair and fulfilled the inclusion criteria. After informed written consent, they were assigned to Foley’s catheter and vaginal pack removal group in 6 hours (group I, n=50) or 24 hours removal group (group II, n=50). Primary parameters used to assess were urine routine and microscopy, urine culture and sensitivity on post-operative day 2, need for re-catheterization and repacking, febrile morbidity, ambulation, vault infection and post-operative hospital stay duration were analyzed in both groups.Results: Febrile morbidity was found in 6% and 8%, Positive urine culture was found in 10% and 20%, Rate of re-catheterization was 10% in group I and group II respectively. Vaginal bleeding after pack removal and repacking was in 6% in group I whilst none had in group II.Conclusions: Early removal was associated with less incidence of urinary tract infection, and increased rate of re-catheterization and repacking. Needs larger comparative studies to support the practice of early removal.

Study of occult stress urinary incontinence in pelvic organ prolapse

Background: Pelvic organ prolapse and stress urinary incontinence are two common health-related conditions. If a woman with pelvic organ prolapse leaks only when the prolapse is reduced, it is called occult stress urinary incontinence (OSUI). The prevalence of OSUI in women with severe genitourinary prolapse varies from 27-68% in literature. In this study we want to find out the relationship between OSUI and stress urinary incontinence (SUI) following corrective surgery.The objectives of the study are to determine the number of women with urinary leak following reduction of prolapse before surgery; to determine the number women with occult stress urinary incontinence developing stress urinary incontinence following surgery and to determine the risk of developing stress urinary incontinence after vaginal hysterectomy and pelvic floor repair in these women.Methods: This is a longitudinal observational study. All women with pelvic organ prolapse (POP) of grade II or higher requiring corrective surgery were initially evaluated for OSUI using vaginal pack and followed up post operatively at 6 weeks and 12 weeks using QUID to look for post-operative stress urinary incontinence (POSUI).Results: The overall incidence of OSUI in our study was 7.5%. OSUI was significantly associated with factors like older age, higher BMI, high parity, short inter pregnancy interval and higher grade of prolapse and not significantly associated with factors like place of delivery, delivery events and mode of delivery.Conclusions: It is important to test all women with POP for OSUI and patients with OSUI need long term follow up to detect POSUI