To identify risk factors associated with postoperative urinary retention in patients undergoing outpatient minimally invasive hysterectomy. Design: A retrospective cohort study. Setting: An academic medical center. Patients: All patients undergoing outpatient minimally invasive hysterectomy between January 2013 and July 2018 were considered for inclusion in the study. Interventions: Outpatient laparoscopic, vaginal, or robotically assisted laparoscopic hysterectomy. Measurements and Main Results: Four hundred forty-four patients met the inclusion criteria. Postoperative urinary retention occurred in 94 patients, and 347 patients successfully passed their voiding trial in the postanesthesia care unit for a pass rate of 79%. Demographic characteristics were similar, except patients who experienced postoperative urinary retention were less likely to be menopausal (23.4% vs 34.7%, p = .038). Those with urinary retention received more perioperative opioids (morphine milligram equivalent of 14.4 mg vs11.2 mg, p = .012), had longer operative times (122.9 § 55.6 vs 95.7 § 42.3 minutes, p < .01), and experienced more blood loss (105.3 § 134.4 vs 78.5 § 86.8 mL, p = .025). The rate of urinary tract infections was similar. Logistic regression analysis showed that the route of hysterectomy and age were not associated with an increased risk for urinary retention, whereas a longer operative time and higher doses of perioperative opioid use were.
Conclusion:In patients undergoing minimally invasive outpatient hysterectomy, a longer operative time and increased perioperative narcotic use increases the risk of postoperative urinary retention.
Objective
To evaluate the survival impact of imaging vs surgical nodal assessment in patients with cervical cancer stage IB2–IVA prior to definitive chemoradiotherapy (CRT).
Methods
PubMed, MEDLINE, Cochrane Library, and ClinicalTrials.gov were used to search for publications in English and Chinese over a 50-year period. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols was used to conduct this review. Inclusion criteria were studies that compared survival outcomes in International Federation of Gynecology and Obstetrics 2009 stage IB2–IVA cervical cancer patients with pre-therapy pelvic and/or aortic lymphadenectomy (LND) or imaging. One or more of the following modalities were used for nodal assessment: computed tomography (CT), magnetic resonance imaging, or positron emission tomography-CT. The National Institutes of Health Quality Assessment Tool was utilized to assess study quality.
Results
The initial search identified 65 studies, and five met the inclusion criteria. There were a total of 1,112 patients. Seven hundred and fifty-four underwent pelvic and/or aortic LND and 358 had imaging. When compared to LND, imaging had a sensitivity and specificity of 88.9% and 22.2% for pelvic lymph node (LN), and 33%–62.5% and 92%–95.5% for para-aortic LN. There were no differences in progression-free survival (PFS) (hazard ratio [HR]=1.13; 95% confidence interval [CI]=0.73–1.74; I
2
=75%; p<0.01) and overall survival (OS) (HR=1.06; 95% CI=0.66–1.69; I
2
=75%; p<0.01) between surgical and imaging nodal assessment.
Conclusions
Imaging and surgical nodal assessment has comparable PFS and OS in patients with cervical cancer stage IB2–IVA.
Trial Registration
PROSPERO Identifier:
CRD42020155486
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