Clinical pathway for tension-free vaginal mesh procedure: evaluation in 300 patients with pelvic organ prolapse.
OBJECTIVE
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.
Kato
Kumiko
K
Department of Female Urology, Japanese Red Cross Nagoya First Hospital, Nagoya, Aichi, Japan. kumi.kato@nifty.com
Suzuki
Shoji
S
Yamamoto
Shigeki
S
Furuhashi
Kenichi
K
Suzuki
Koichi
K
Murase
Tatsuro
T
Gotoh
Momokazu
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015907:Hysteroscopy / Q000379:methods; D007564:Japan; D007902:Length of Stay; D008875:Middle Aged; D010149:Postoperative Pain / Q000503:physiopathology; D017060:Patient Satisfaction; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology; D011300:Preoperative Care / Q000379:methods; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D053825:Suburethral Slings; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000175:diagnosis* / Q000601:surgery*