Article Data

  • Views 815
  • Dowloads 161

Original Research

Open Access Special Issue

The impact of post-operative voiding trial on length of stay following laparoscopic hysterectomy: a prospective, randomized control trial

  • Michelle Davis1,†,*,
  • Kathryn Barletta2,†
  • Alexcis Ford3
  • Roni Nitecki4
  • Kevin M. Elias1
  • Ross Berkowitz1
  • Colleen Feltmate1

1Division of Gynecologic Oncology, Brigham and Women’s Hospital, Harvard Medical School, Boston, 02115 MA, USA

2Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, Boston, 02115 MA, USA

3Division of Urogynecology, Advanced Gynecology, Roswell, 30076 GA, USA

4Division of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, 30076 Tx, USA

DOI: 10.31083/j.ejgo.2021.01.2293 Vol.42,Issue 1,February 2021 pp.110-117

Submitted: 02 October 2020 Accepted: 16 December 2020

Published: 15 February 2021

(This article belongs to the Special Issue Minimally Invasive Surgery in Gynecologic Oncology)

*Corresponding Author(s): Michelle Davis E-mail:

† These authors contributed equally.


Objective: Same day discharge (SDD) is feasible following laparoscopic hysterectomy (TLH) in gynecologic oncology patients resulting in low complication and re-admission rates. Following vaginal surgery, backfill or active voiding trials have been shown to reduce hospital discharge with a catheter. The aim of this study is to determine if performing an active backfill voiding trial (AVT) vs. passive voiding trial (PVT) leads to expedited discharge following TLH. Methods: Subjects scheduled for SDD TLH were enrolled and randomized to an AVT or a PVT. The primary outcome was length of stay. Secondary outcomes include time to void, catheter replacement, admission to the extended recovery unity (ERU), post-operative pain, and complications. Results: 121 patients were randomized: 60 to an AVT and 61 to a PVT. There was a statistically significant reduction in median length of stay for patients undergoing an AVT vs. PVT (271.5 minutes vs. 329 minutes, P = 0.015). Median time to void was also decreased with an AVT vs. PVT (30 minutes vs. 289 minutes, P < 0.001). There was no difference in median pain score (2), catheter replacement, peri-operative complications, or overnight admissions between the two groups. Conclusion: There is a significant reduction in time to void and total length of stay in patients randomized to a backfill voiding trial following TLH with no increased patient discomfort. While the numbers of post-operative admissions were low and underpowered to detect a difference in admission rate, these data will help to streamline post-operative care for SDD gynecologic oncology patients.


Same day discharge; Laparoscopic hysterectomy; Voiding trial; Perioperative outcomes

Cite and Share

Michelle Davis,Kathryn Barletta,Alexcis Ford,Roni Nitecki,Kevin M. Elias,Ross Berkowitz,Colleen Feltmate. The impact of post-operative voiding trial on length of stay following laparoscopic hysterectomy: a prospective, randomized control trial. European Journal of Gynaecological Oncology. 2021. 42(1);110-117.


[1] Lee J, Jennings K, Borahay MA, Rodriguez AM, Kilic GS, Snyder RR, et al. Trends in the national distribution of laparoscopic hysterectomies from 2003 to 2010. Journal of Minimally Invasive Gynecology. 2014; 21: 656-661.

[2] Pitter MC, Simmonds C, Seshadri-Kreaden U, Hubert HB. The impact of different surgical modalities for hysterectomy on satisfaction and patient reported outcomes. Interactive Journal of Medical Research. 2014; 3: e11.

[3] Schiavone MB, Herzog TJ, Ananth CV, Wilde ET, Lewin SN, Burke WM, et al. Feasibility and economic impact of same-day discharge for women who undergo laparoscopic hysterectomy. American Journal of Obstetrics and Gynecology. 2012; 207: 382. e1-382.e9.

[4] Galaal K, Bryant A, Fisher AD, Al-Khaduri M, Kew F, Lopes AD. Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database of Systematic Reviews. 2012; 9: CD006655.

[5] Cohen SL, Ajao MO, Clark NV, Vitonis AF, Einarsson JI. Outpatient hysterectomy volume in the United States. Obstetrics & Gynecology. 2017; 130: 130-137.

[6] Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: gynecologic oncology group study LAP2. Journal of Clinical Oncology. 2009; 27: 5331-5336.

[7] Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, et al. Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: gynecologic oncology group LAP2 study. Journal of Clinical Oncology. 2012; 30: 695-700.

[8] Scalici J, Laughlin BB, Finan MA, Wang B, Ro cconi RP. The trend towards minimally invasive surgery (MIS) for endometrial cancer: an ACS-NSQIP evaluation of surgical outcomes. Gynecologic Oncology. 2015; 136: 512-515.

[9] Shepherd JP, Kantartzis KL, Ahn KH, Bonidie MJ, Lee T. Cost analysis when open surgeons perform minimally invasive hysterectomy. Journal of the Society of Laparoendoscopic Surgeons. 2014; 18: e2014.00181.

[10] Warren L, Ladapo JA, Borah BJ, Gunnarsson CL. Open abdominal versus laparoscopic and vaginal hysterectomy: analysis of a large United States payer measuring quality and cost of care. Journal of Minimally Invasive Gynecology. 2009; 16: 581-588.

[11] Melamed A, Katz Eriksen JL, Hinchcliff EM, Worley M, Berkowitz RS, Horowitz NS, et al. Same-day discharge after laparoscopic hysterectomy for endometrial cancer. Gynecologic Oncology. 2015; 137: 37-38.

[12] Nahas S, Feigenberg T, Park S. Feasibility and safety of same-day discharge after minimally invasive hysterectomy in gynecologic oncology: a systematic review of the literature. Gynecologic Oncology. 2016; 143: 439-442.

[13] Korsholm M, Mogensen O, Jeppesen MM, Lysdal VK, Traen K, Jensen PT. Systematic review of same-day discharge after minimally invasive hysterectomy. International Journal of Gynecology & Obstetrics. 2017; 136: 128-137.

[14] Geller EJ. Prevention and management of postoperative urinary retention after urogynecologic surgery. International Journal of Women’s Health. 2014; 6: 829-838.

[15] Ghezzi F, Cromi A, U ccella S, Colombo G, Salvatore S, Tomera S, et al. Immediate Foley removal after laparoscopic and vaginal hysterectomy: determinants of postoperative urinary retention. Journal of Minimally Invasive Gynecology. 2007; 14: 706-711.

[16] Geller EJ, Hankins KJ, Parnell BA, Robinson BL, Dunivan GC. Diagnostic a ccuracy of retrograde and spontaneous voiding trials for postoperative voiding dysfunction: a randomized controlled trial. Obstetrics & Gynecology. 2011; 118: 637-642.

[17] Foster RT, Borawski KM, South MM, Weidner AC, Webster GD, Amundsen CL. A randomized, controlled trial evaluating 2 techniques of postoperative bladder testing after transvaginal surgery. American Journal of Obstetrics and Gynecology. 2007; 197: 627.e1-627.e4.

[18] Toyonaga T, Matsushima M, Sogawa N, Jiang SF, Matsumura N, Shimojima Y, et al. Postoperative urinary retention after surgery for benign anorectal disease: potential risk factors and strategy for prevention. International Journal of Colorectal Disease. 2006; 21: 676-682.

[19] Keita H, Diouf E, Tubach F, Brouwer T, Dahmani S, Mantz J, et al. Predictive factors of early postoperative urinary retention in the postanesthesia care unit. Anesthesia & Analgesia. 2005; 101: 592-596.

[20] Pulvino JQ, Duecy EE, Buchsbaum GM, Flynn MK. Comparison of 2 techniques to predict voiding efficiency after inpatient urogynecologic surgery. Journal of Urology. 2010; 184: 1408-1412.

[21] Alessandri F, Mistrangelo E, Lijoi D, Ferrero S, Ragni N. A prospective, randomized trial comparing immediate versus delayed catheter removal following hysterectomy. Acta Obstetricia et Gynecologica Scandinavica. 2006; 85: 716-720.

[22] Foundation W-BF. Wong-Baker FACES® Pain Rating Scale. 2016.

[23] Erekson EA, Yip SO, Ciarleglio MM, Fried TR. Postoperative complications after gynecologic surgery. Obstetrics & Gynecology. 2011; 118: 785-793.

[24] Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases. 1987; 40: 373-383.

[25] Macario A, Vitez TS, Dunn B, McDonald T. Where are the costs in perioperative care? Analysis of hospital costs and charges for inpatient surgical care. Anesthesiology. 1995; 83: 1138-1144.

[26] Fleisher L, Metzger S, Lam J, Harris A. Perioperative costfinding analysis of the routine use of intraoperative forced-air warming during general anesthesia. Anesthesiology. 1998; 88: 1357-1364.

[27] Anderson R, Saiers JH, Abram S, Schlicht C. A ccuracy in equianalgesic dosing. Conversion dilemmas. Journal of Pain and Symptom Management. 2001; 21: 397-406.

[28] Elliott TE. Principles of analgesic use in the treatment of acute pain and cancer pain. 4th edition. Glenview, IL: American Pain Society. 1999.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Submission Turnaround Time