Catheter Free Day of Surgery Discharge vs Overnight Observation Following Artificial Urinary Sphincter Placement

Abstract

IntroductionTo confirm the safety and examine outcomes of a day of surgery discharge following artificial urinary sphincter implantation in a population discharged without a catheter. MethodsWe retrospectively identified 110 patients, 31 of whom were discharged on the day of surgery, from a single surgeon following artificial urinary sphincter implantation. After institutional board review approval, patient charts were reviewed capturing demographics as well as three, thirty, and ninety-day outcomes. Further outcomes specific to urinary retention were obtained. ResultsPatients who were discharged the same day were older (71 vs. 68), had shorter operative times (92 minutes vs 109 minutes), and were less likely to have been smokers (6% vs 31%). There were no differences in the proportion of patients who underwent prior radiation or prior implant surgery. There was no significant difference in the number of patients who had emergency department visits, urinary retention, office calls, office visits, or unplanned office visits at all time points following surgery. There was no significant difference in overall urinary retention (15% vs 5%), retention presenting after the initial surgical event (6% vs 5%), or need for a suprapubic tube (0% vs 5%). ConclusionsDay of surgery discharge is a safe discharge strategy for patients who have undergone artificial urinary sphincter placement. Furthermore, catheter-free days of discharge surgery did not have a significantly greater risk of urinary retention, office calls, emergency department (ED) visits, or office visits compared to our overnight observation population. This approach should be considered for all patients undergoing artificial urinary sphincter (AUS) implantation.

Editorial Comment

“…Similarly, this shift in practice is also evident among patients undergoing insertion of an artificial urinary sphincter (AUS) and has been demonstrated by early adopters of this practice. [1][2][3][4] Kozar et al reported a multi-institutional study evaluating postoperative catheter management after insertion of a first-time AUS. 5 The rates of urinary retention and complications were compared for patients leaving the procedure without a catheter vs those with a catheter in place for approximately 24 hours after AUS.…”