Evaluation of safety and feasibility of ambulatory urogynaecological procedures in a 24-h setting.

INTRODUCTION AND HYPOTHESIS: Our aim is to assess the safety and feasibility of ambulatory urogynaecological procedures in a 24-h day case surgery setting. METHODS: We evaluated women who underwent urogynaecological procedures in the 2-year period from April 2006 to March 2008 in an ambulatory care setting. Proportion of patients being discharged within 24 h was noted. Re-admission rate, prolonged inpatient stay and post-operative complications were analysed. RESULTS: Three hundred eighteen patients underwent urogynaecological procedures during the study period. Mean age was 58 +/- 13.8 (range: 19-92) and median parity was 3 (0-10). Forty-one (12.89%) women had hysterectomy previously and 99 (31.13%) were post-menopausal. There were no intra-operative complications except bladder injury in one patient. Of the patients, 272 (85.5%) were discharged in 24-h ambulatory protocol. Remaining 46 (14.4%) required inpatient admission. CONCLUSIONS: A variety of urogynaecological procedures can be performed in a 24-h ambulatory care setting. Our study suggests that this practice is proven to be safe and feasible.

Reproducibility of the transvaginal sonographic assessment of bladder wall thickness.

OBJECTIVE: To assess whether transvaginal sonographic measurements of bladder wall thickness (BWT) have adequate reproducibility to detect differences in BWT potentially indicative of detrusor overactivity in women with overactive bladder. STUDY DESIGN: Three reproducibility studies were undertaken to assess (A) total measurement error, (B) intra-observer variability and (C) inter-observer measurement in the interpretation of scans. Women recruited to the Bladder Ultrasound Study underwent a transvaginal ultrasound scan to obtain a measurement of BWT. When a second observer was available, women who agreed to have two transvaginal scans by different operators were recruited into study A. For study B the first observer reassessed a sample of the recorded images at a later date whilst for study C, a random selection of BWT images were read by a second assessor. Analytical variability, percentage of variability attributable to measurement error, within-person variation and the smallest real difference detectable were estimated. RESULTS: One hundred and twenty-one women took part: 27 had repeat scans, 37 had scans re-read by the same observer, and 57 had scans read by two observers. In study A, 39% of the total variability in measurements was explained by measurement error (the remainder to within person change); the standard deviation (SD) of measurement error was 0.76mm and the smallest detectable clinical difference was 2.1mm. The SD of measurement error from scan interpretation was 0.42mm within observers (study B) and 0.35mm between observers (studyC). CONCLUSION: The high levels of measurement error for a small measurement of BWT means it is unlikely Transvaginal ultrasound measurements have insufficient reliability and reproducibility to be an accurate diagnostic test.