Analysis of voiding dysfunction after transobturator tape procedure for stress urinary incontinence

Abstract

PurposeThe definition of posttransobturator tape procedure (post-TOT) voiding dysfunction (VD) is inconsistent in the literature. In this study, we retrospectively investigated the risk factors for post-TOT VD by applying various definitions in one cohort.Materials and MethodsThe medical records of 449 patients were evaluated postoperatively. Acute urinary retention requiring catheterization, subjective feeling of voiding difficulty during follow-up, and postoperative postvoid residual (PVR) greater than 100 mL or PVR greater than 50% of voided volume (significant PVR) were adopted for the definition of VD. With these categories, multivariate analysis was performed for risk factors of postoperative VD.ResultsTen patients (2.2%) required catheterization, 47 (10.5%) experienced postoperative voiding difficulty, and 63 (14.7%) showed significant PVR. In the multivariate logistic analysis, independent risk factors for postoperative retention requiring catheterization were previous retention history (p=0.06) and preoperative history of hysterectomy. Risk factors for subjective postoperative voiding difficulty were underactive detrusor (p=0.04) and preoperative obstructive voiding symptoms (p<0.01). Previous urinary retention history (p<0.01)) was an independent risk factor for concomitant postoperative voiding difficulty and significant PVR. Spinal anesthesia (p=0.02) and previous urinary retention history (p=0.02) were independent risk factors for significant postoperative PVR.ConclusionsWith the use of several definitions of VD after the midurethral sling procedure, postoperative peak flow rate and PVR were significantly different between groups. Although there were no independent risk factors consistent with various definitions of VD, preoperative obstructive voiding symptoms and objective parameters suggesting impaired detrusor tend to have predictive power for post-TOT VD.

Surgical outcome of the transobturator tape procedure for management of female urinary incontinence: A single center experience

“…Observed risk factors can be preoperative voiding difficulties or exceeding the tension on the tape. Ahn et al in their study reported 10.5% patients had postoperative voiding difficulties, 2,2% needed prolonged catheterization due to retention and 0.4% underwent sling incision as a definite solution of voiding difficulties (22). Kim et al in their study reported an incidence of 9.5% of patients with transient retention (TR) and suggested that preoperative PVR can be noted as a risk factor for developing TR (23).…”

Impact of Preoperative Patient Characteristics and Flow Rate on Failure, Early Complications, and Voiding Dysfunction After a Transobturator Tape Procedure: A Multicentre Study

“…Nevertheless, other studies have failed to demonstrate urodynamic predictors of post-MUS voiding dysfunction. Chang et al [ 34 ] postoperatively evaluated 449 patients who underwent TOT. Preoperative urodynamic parameters did not demonstrate reproducible predictors of voiding dysfunction.…”

Urineretentie na plaatsen transobturator tape: eerst een nachtje over slapen?

“…Er werd gestart met katheteriseren wanneer er sprake was van urineresiduen van 150 ml of meer na driemaal spontane mictie. De incidentie van mictieproblemen na een TOT loopt in de literatuur sterk uiteen en hangt af van de definitie die voor mictieproblemen wordt gehanteerd [9]. Hoe vaak de indicatie voor zelfkatheterisatie wordt gesteld, hangt ook af van hoe en op welk moment het urineresidu wordt vastgesteld en de afkapwaarde die voor het post void residual (PVR) wordt gehanteerd.…”

“…Hoe vaak de indicatie voor zelfkatheterisatie wordt gesteld, hangt ook af van hoe en op welk moment het urineresidu wordt vastgesteld en de afkapwaarde die voor het post void residual (PVR) wordt gehanteerd. De incidentie van de noodzaak tot katheterisatie na een TOT loopt in de verschillende studies dan ook uiteen van 2,2 tot 22 % [9][10][11][12].…”

“…Het is niet duidelijk welke patiëntfactoren de kans op urineretentie na een TOT vergroten, maar mogelijk is het risico verhoogd bij preoperatieve obstructieve mictieklachten en verminderde detrusorwerking [9]. Deze patiëntfactoren zijn in onze studie niet apart bekeken.…”