title: Early postoperative bladder training in patients submitted to radical hysterectomy: is it still necessary? A randomized trial.
abstract: OBJECTIVE
  To evaluate the role of bladder training during postoperative hospital stay in patients submitted to nerve-sparing radical hysterectomy, and to identify any clinical or surgical factor associated with postoperative bladder dysfunction.
  
  
  METHODS
  Parallel group randomized single institution trial, on gynaecologic malignancies patients conducted in Catholic University of Sacred Heart Rome, between April 2009 and November 2011. Randomization was on 1:1, using a block randomized computer-generated list.
  
  
  METHODS
  Patients underwent Querleu-Morrow type B2 or C1 radical hysterectomy. After 2 days from surgery, patients were randomized to perform or not bladder training (scheduled clamping and unclamping of the trans-urethral catheter every three hours). Main outcome measures Necessity and duration of clean intermittent self catheterization.
  
  
  RESULTS
  Randomized participants were 111 women (bladder training arm n = 55; control arm n = 56). A total of 22 women (19.8%) required clean intermittent self catheterization, equally distributed in the two arms. At univariate analysis, only the type of radical hysterectomy was significantly associated with need of clean intermittent self catheterization (type C1 vs. type B2; p = 0.013). At univariate analysis, duration of clean intermittent self-catheterization was not associated with age, BMI, type of hysterectomy and of neo-adjuvant treatment.
  
  
  CONCLUSIONS
  Functional bladder disfunctions are the most common long-term complications following radical hysterectomy. Systematic postoperative bladder training following nerve-sparing radical hysterectomy does not influence the rate of urinary retention or re-admission for bladder catheterization.
authors.affiliation: Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy, francesco.fanfani@rm.unicatt.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fanfani
authors.forename: Barbara
authors.initials: B
authors.lastname: Costantini
authors.forename: Floriana
authors.initials: F
authors.lastname: Mascilini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Vizzielli
authors.forename: Valerio
authors.initials: V
authors.lastname: Gallotta
authors.forename: Massimo
authors.initials: M
authors.lastname: Vigliotta
authors.forename: Emilio
authors.initials: E
authors.lastname: Piccione
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
authors.forename: Anna
authors.initials: A
authors.lastname: Fagotti
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000534:rehabilitation; D007902:Length of Stay; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications; D011184:Postoperative Period; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology; D014546:Urinary Catheterization / Q000009:adverse effects / Q000379:methods*; D016055:Urinary Retention / Q000209:etiology