Implementation of a standardized voiding protocol after minimally invasive surgery in gynecologic oncology: a quality improvement initiative

Objectives: Urinary retention after pelvic surgery is common and contributes to postoperative catheter-associated urinary tract infection (UTI). The aim of our quality improvement study was to reduce the rate of UTI by 50% during the study period. Methods: A standardized voiding protocol was designed and implemented in patients undergoing minimally invasive hysterectomy for gynecologic malignancy between January to September 2020. The protocol included: 1) aseptic indwelling catheter insertion technique, 2) use of a new catheter for every insertion attempt, 3) proper positioning of the catheter bag below the patient's bladder on the side of the table during surgery, 4) catheter removal immediately after surgery prior to transfer to recovery room, 5) bladder scan after void, 6) and limiting repeat catheterizations for retention (Figure 1). We compared the demographics, time to first void, rate of urinary retention, and UTI rates between the pre- and post-protocol cohorts. Data for the historical cohort was obtained using the National Surgical Quality Improvement Program (NSQIP) database. Chi-square and Fisher's exact tests were used for comparison of categorical variables and Wilcoxon Rank-Sum tests for continuous variables. Results: A total of 79 post-protocol patients were compared to 124 patients in a historical cohort. The post-implementation cohort was younger (59 vs 65; p=0.04) but clinical and surgical characteristics were not statistically different between the two cohorts. The voiding protocol led to a significant decrease in the interval to first void (289 vs 526 minutes; p Conclusions: Implementation of a standardized voiding protocol was associated with a significant reduction in time to first void, and 50% decreased catheter-associated UTI.