4.2. Results in context of ERAS programmes
We obtained no data on urinary retention or length of stay. However, a case-control study that evaluated vaginal packing together with other interventions within an ERAS programme concluded that packing might negatively affect both hospital stay and costs (18). The study group comprised women undergoing vaginal hysterectomy who had been enrolled in an ERAS program where the standard practice was not to pack the vagina. After reviewing the results of packing together with other interventions within ERAS pathways for vaginal hysterectomy, Kalogera et al. (19) and Jeppson et al. (22) came to the same conclusions.
Though we could not obtain data on the effect of vaginal packing alone on urinary retention and length of admission, it seems logical that any impact of vaginal packing on bladder emptying will be negative. A tight gauze in the vagina can be expected to exert compression on the bladder neck and urethra, thus making it difficult to void spontaneously. Due to this belief, many surgeons prefer to place an indwelling bladder catheter while the vagina remains packed, with both interventions usually performed in tandem and likely to present barriers to early discharge.
Overall, we found that the intervention offered no clear benefit for the predefined outcomes.