Abstract Objective: To compare rates of urinary retention and postoperative urinary tract infection between women with immediate versus delayed removal of indwelling catheter following benign non-hysterectomy gynecological laparoscopic surgery. Design: This randomized clinical trial was conducted between February 2012 and December 2019, with follow-up to six weeks, in two university-affiliated hospitals in Sydney, Australia. Population: Study participants were 693 women over 18 years of age, undergoing non-hysterectomy laparoscopy for benign gynecological conditions, excluding pelvic floor or concomitant bowel surgery. Methods: 355 participants were randomized to immediate, and 338 to delayed removal of urinary catheter. Main Outcome Measures: The co-primary outcomes were urinary retention (assessed by trial of void and need to re-catheterize) and urinary tract infection. Secondary outcomes included readmission, analgesia requirements, duration of hospitalization and validated bladder function questionnaires. Results: Urinary retention for participants in the immediate removal group was statistically higher at 8.2% (95% CI: 5.7% to 11.4%) vs. 4.2% (95% CI: 2.7% to 7.2%) in the delayed removal group (p=.03). There was no statistically significant difference in the rates of urinary tract infection between the groups at 7.2% (95% CI:4.7% to 10.8%) in the delayed group vs. 4.7% (95% CI: 2.8% to 7.8%) in the immediate group. Conclusions: Rates of urinary retention and urinary tract infection following non-hysterectomy benign gynecological laparoscopy are low. There is a small increased risk of urinary retention with immediate compared with delayed removal of urinary catheter. These findings can be used to counsel patients regarding postoperative bladder care.

Background: Reproductive complications for cancer survivors are identified as one of the top unmet needs. Current models of care do not routinely incorporate reproductive follow-up for cancer patients. The Kids Cancer Centre have had a one stop survivorship clinic which includes a gynecologist and fertility specialist. Methodology: To inform the future development of our reproductive survivorship care we audited this service over a twelve-year period reviewing who used the service and their gonadotoxic risk, their reproductive needs and concerns. Main results: 278 patients were seen (397 consultations), including 189 female patients (68.0%). Median age at follow up was 25.0 years (range=6-50) and they were 19.2 years from their primary diagnosis (range=3-46). We identified 10 themes of reproductive need. Patients had on average 2.5 reproductive concerns documented per consultation (range 1-5). The three most commonly documented concerns at initial consultation related to fertility status (43.9%), endocrine dysfunction (35.3%), and contraception advice (32.4%). In patients younger than 25 years discussions were predominately about endocrine dysfunction, fertility status and contraception, while dominant themes for 26-35 years olds were fertility status, reproductive-related health prevention strategies, contraception and endocrine dysfunction. Survivors aged 36-45 prioritised fertility status, pregnancy, and contraception. Fertility preservation (p=0.05), preventative health strategies (p=0.001), and contraception advice (p<0.001) were more commonly discussed by females than males. Conclusion: Longitudinal reproductive follow up care is important, as patients have a number of ongoing reproductive concerns which change over time. Our data can assist in informing the model of care.