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Diagnostic Accuracy of Retrograde and Spontaneous Voiding Trials for Postoperative Voiding Dysfunction: A Randomized Controlled Trial

Geller, Elizabeth J. MD; Hankins, Kelly J. MD; Parnell, Brent A. MD; Robinson, Barbara L. MD; Dunivan, Gena C. MD

doi: 10.1097/AOG.0b013e318229e8dd
Original Research

OBJECTIVE: To compare the diagnostic accuracy of two voiding trial methods to predict postoperative voiding dysfunction.

METHODS: Women undergoing operations for urinary incontinence, prolapse, or both urinary incontinence and prolapse from November 2009 and March 2010 were randomized into one of two groups: retrograde or spontaneous. All patients underwent both techniques of voiding trials with randomization determining order.

RESULTS: Fifty women were randomized to 25 per group. Failure rates were 62% for retrograde and 84% for spontaneous. Women who failed both had 12.6±14.4 days of retention compared with 2.5±2.1 days for those who failed only one method (P=.004). The retrograde method had 94.4% sensitivity and 58.1% specificity to detect postoperative voiding dysfunction lasting at least 7 days compared with the spontaneous method with 100% sensitivity and 25.8% specificity. Positive and negative predictive values for the retrograde method were 56.7% and 94.7%, respectively, compared with the spontaneous method with 43.9% and 100%. Retrograde was preferred by patients (51.1% compared with 44.4%) regardless of randomization.

CONCLUSION: The retrograde method is more accurate in evaluating postoperative voiding dysfunction, although both tests had a low positive predictive value. A longer period of retention was seen with failure of both methods. Retrograde was preferred by patients and provides an efficient alternative to the spontaneous method of voiding trial.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01091844.

LEVEL OF EVIDENCE: I

The retrograde method of voiding trial has more diagnostic accuracy than the spontaneous method in predicting postoperative voiding dysfunction.

From the Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Presented at the 31st Annual Scientific Meeting of the American Urogynecology Society, September 29–October 2, 2010, Long Beach, California.

Corresponding author: Elizabeth J. Geller, MD, University of North Carolina at Chapel Hill, Department of Obstetrics and Gynecology, CB #7570, Chapel Hill, NC 27599-7570; e-mail: egeller@med.unc.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.