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Clinical pathway for tension-free vaginal mesh procedure: evaluation in 300 patients with pelvic organ prolapse.

Abstract

OBJECTIVES
To evaluate a clinical pathway of discharge on postoperative day 3 for the tension-free vaginal mesh (TVM) procedure in patients with pelvic organ prolapse (POP).
METHODS
Between May 2006 and December 2007, 305 consecutive women with POP quantification stage 3 or 4 were planned to undergo the TVM procedure in a single general hospital. Excluding five patients with concomitant hysterectomy, a pathway (removal of the indwelling urethral catheter on the next morning, discharge on postoperative day 3) was applied to the remaining 300 patients. The perioperative complications and postoperative hospitalization were prospectively evaluated in this case series.
RESULTS
Perioperative complications were: bladder injury (11 cases, 3.7%), vaginal wall hematoma (two cases, 0.7%), rectal injury (one case, 0.3%) and temporary hydronephrosis (one case, 0.3%). None needed blood transfusion. The indwelling urethral catheters were removed on the next morning as in the pathway in 287 cases (95.6%), and none required clean intermittent catheterization at home. Postoperative hospitalization was within 3 days in 280 cases (93.3%). The six cases (2.0%) with longer hospitalization were due to complications (two cases of bladder injury, one of rectal injury, one of blood loss over 200 mL, one of temporary urinary retention, and one of hydronephrosis). Two patients were re-hospitalized within one month due to vaginal bleeding or gluteal pain.
CONCLUSIONS
Patients generally accepted the pathway of discharge on postoperative day 3 in spite of the Japanese culture preferring a longer hospital stay.

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  • Publisher Full Text
  • Authors

    Kato K, Suzuki S, Yamamoto S, Furuhashi K, Suzuki K, Murase T, Gotoh M

    Institution

    Department of Female Urology, Japanese Red Cross Nagoya First Hospital, Nagoya, Aichi, Japan. kumi.kato@nifty.com

    Source

    International journal of urology : official journal of the Japanese Urological Association 16:3 2009 Mar pg 314-7

    MeSH

    Adult
    Aged
    Aged, 80 and over
    Cohort Studies
    Female
    Follow-Up Studies
    Gynecologic Surgical Procedures
    Humans
    Hysteroscopy
    Japan
    Length of Stay
    Middle Aged
    Pain, Postoperative
    Patient Satisfaction
    Postoperative Care
    Postoperative Complications
    Preoperative Care
    Quality of Life
    Retrospective Studies
    Risk Assessment
    Severity of Illness Index
    Suburethral Slings
    Treatment Outcome
    Uterine Prolapse

    Pub Type(s)

    Evaluation Studies
    Journal Article

    Language

    eng

    PubMed ID

    19207605