Comparing Force of Stream to Retrograde Fill Voiding Trial After Vaginal Apex Suspension
Comparing Force of Stream to Retrograde Fill Voiding Trial After Vaginal Apex Suspension
Voiding difficulties are common after prolapse and incontinence surgeries. All patients after
 vaginal prolapse surgery must complete a voiding trial if they are to be discharged home
 without a catheter. Accepted protocols for voiding trials after prolapse and incontinence
 surgeries do not exist. The purpose of this study is to compare two different types of
 postoperative voiding trials to determine which leads to less postoperative issues, such as
 urinary retention requiring catheterization. You are being asked to participate because you
 are having a vaginal apex suspension surgery.
It is common to have voiding difficulties after prolapse and incontinence surgeries.
 Difficulties in voiding are seen in up to 47% of patients after transvaginal prolapse surgery
 in the immediate hours postoperatively (6). Accepted protocols for voiding trials after
 prolapse and incontinence surgeries do not exist. Traditionally, many surgeons measure
 postvoid residual (PVR) urine volume to assess incomplete bladder emptying by retrograde
 filling the bladder with a predetermined amount of normal saline or water. The catheter is
 then removed and the patient is permitted to void into a collection basin. The need for
 postoperative catheterization is generally based on arbitrarily determined ratios of voided
 urine to PVR. The force of stream trial (FAST) does not prioritize amount voided, but rather
 the patient's subjective force of stream. Using FAST, a patient uses a visual analog scale
 (VAS) scale to quantify her force of stream. If she states that her Force of Stream (FOS) is
 >50% of her baseline prior to surgery, independent of the amount voided, she is discharged
 without a catheter. If the FOS is <50%, a PVR is measured via bladder scan. If her PVR is
 <500cc the patient is discharged home.

 No randomized control trials (RCT) have been performed comparing the FAST method to the
 traditional retrograde voiding trial in subjects undergoing vaginal apex prolapse surgery
 despite the promising findings that FAST voiding trials are as reliable and safe as
 retrograde voiding trials in patients undergoing anti-incontinence surgeries. Standard in our
 practice is to perform a voiding trial on postoperative day 1 on all patients after vaginal
 apical prolapse surgery if they are to be discharged without a catheter. Investigators would
 like to compare the FAST voiding trial to a traditional retrograde fill voiding trial with
 respect to the rate of catheterization among those discharged without a catheter within the
 six-week postoperative period in patients undergoing a vaginal apex prolapse surgery.
 Investigators hypothesize the FAST voiding trial method is not inferior to traditional
 retrograde voiding trial. Subjects will complete questionnaires to examine postoperative
 bladder function, symptom distress and quality of life before and after surgery during their
 routine postoperative visits.
Inclusion Criteria:

 1. Women undergoing vaginal apex surgery (sacrocolpopexy, sacrospinous ligament suspension,
 uterosacral ligament suspension, colpocleisis) with or without mid-urethral sling, with or
 without anterior or posterior colporrhaphy

 Exclusion Criteria:

 1. Patients who underwent a surgery that requires long term catheterization (i.e fistula
 repair or urethral diverticulum)

 2. Patients who sustained a cystotomy during surgery as our divisional protocol is to
 send these patients home with a Foley catheter for 5-14 days without a voiding trial

 3. Patients with baseline urinary retention and the inability to urinate without
 catheterization

 4. Pregnant women