Incidence of Postoperative Voiding Dysfunction Following Gynecologic Oncology Surgery

INTRODUCTION: Outside of radical hysterectomies, literature surrounding postoperative voiding after gynecologic oncology surgery remains limited. OBJECTIVE: To determine the incidence of postoperative voiding dysfunction after major gynecologic oncology surgery. METHODS: We performed a retrospective observational study at a single tertiary care center of adult women undergoing major gynecologic oncology surgery between November 2020 and November 2023. Hysterectomy, staging procedures, and tumor debulking for confirmed or presumed gynecologic cancer were included. Women with preoperative urinary retention, neurologic disease affecting voiding, or concomitant prolapse or incontinence procedures were excluded. Postoperative voiding dysfunction was defined as failed voiding trial, replacement of indwelling Foley catheter, or need for intermittent self-catheterization within 30 days of surgery. As a part of routine care, patients underwent passive or active voiding trials at the time of Foley removal postoperatively. Type of voiding trial performed was at the discretion of the surgeon. Failed active voiding trial was defined as voiding 6 hours after Foley catheter removal with a post-void residual volume of >300 mL. Patient demographics, clinical characteristics, surgical details, and postoperative outcomes were abstracted from the medical chart. Standard descriptive analysis and group comparisons were performed. RESULTS: Four hundred and nineteen women underwent major gynecologic oncology procedures. Table 1 highlights the rate of postoperative voiding dysfunction following major gynecologic oncology surgery. Seventeen (4.1%) women were diagnosed with voiding dysfunction postoperatively, all diagnosed based on failed passive voiding trials. Nine (52.9%) cases were diagnosed in the post-anesthesia care unit, and eight (47.1%) were diagnosed during the inpatient postoperative admission. Median duration of voiding dysfunction was 1 day (range 1–31), and 2 (0.5%) women experienced prolonged voiding dysfunction. After an initial failed voiding trial, patients had a repeat passive voiding trial within 24 hours. Patients who failed the repeat voiding trial were discharged with a Foley catheter and scheduled for an active voiding trial within 1 week. Active voiding trials were performed weekly until the patient was able to void sufficiently. Table 2 displays the participant demographics, clinical characteristics, and surgical outcomes of the entire cohort and women with postoperative voiding dysfunction. Of women diagnosed with voiding dysfunction, median age was 66 years (54–82) and BMI was 27.1 kg/m2 (18.5–49.0). The most common surgical indications were endometrial (35.3%) and ovarian cancer (23.5%). Eight (47.1%) cases were performed via an open route, and eight were robotic-assisted (47.1%) approaches. Fifteen (88.2%) had a concomitant hysterectomy. No women with postoperative voiding dysfunction were discharged the same day of surgery. Table 2 also displays variables associated with voiding dysfunction after major gynecologic oncology surgery. Women with voiding dysfunction were more likely to be older (66.8 years versus 60.8, p=0.02). Otherwise, participant demographics, clinical characteristics, and perioperative outcomes were similar between groups. CONCLUSIONS: Postoperative voiding dysfunction occurred in 4.1% of women undergoing major gynecologic oncology surgery. All cases were identified following a failed passive voiding trial, and older women were more likely to experience postoperative voiding dysfunction after surgery.Table 1Table 2