Effect of Preoperative Flow Rate on Postoperative Retention and Voiding Difficulty After Transobturator Tape Operation

Abstract

PurposeControversy exists over the preoperative risk factors for postoperative urinary retention after the midurethral sling procedure for stress urinary incontinence (SUI). We intended to analyze the effect of preoperative flow rate on postoperative urinary retention after the transobturator tape (TOT) operation.Materials and MethodsA total of 322 patients who underwent TOT from June 2006 to May 2012 were included in this retrospective study. All patients were preoperatively investigated for urinary symptoms and underwent preoperative urodynamic studies including urine flow rate. Postoperative urinary retention, voiding difficulty, and uroflowmetry were checked. Urinary retention was defined as the need for additional catheterization longer than 1 day. Patients were divided by preoperative peak flow rate (Qmax) of 15 mL/s (low Qmax group and normal Qmax group).ResultsThere were 3 cases of postoperative urinary retention (0.9%) and 52 cases of voiding difficulty (16.1%). The low Qmax group included 40 patients (12.4%) and the normal Qmax group included 282 patients (87.5%). Between the two groups, there were no significant differences in age, previous pelvic surgery history, or past medical history. The low Qmax group had higher scores for voided volume and detrusor pressure at Qmax. However, there was no significant difference in postoperative voiding difficulty between the two groups. Furthermore, three patients who experienced postoperative retention showed high flow rates preoperatively.ConclusionsOur results suggest that voiding difficulty in the group with low preoperative flow was tolerable and the treatment success rate was comparable to that in patients in the normal flow group. According to our analysis, patients with a low flow rate preoperatively can be safely treated with TOT for SUI.

High urinary flow in women with stress incontinence: corrected flow–age nomogram evaluation after a transobturator tape procedure

“…In the TOT procedure, postoperative urinary retention had no correlation with preoperative urinary [11]. Two red circles indicate the patients who needed cholinergic agents after the TOT procedure flow rates [18]; however, previous studies demonstrated that preoperative Qmax below 15 mL/s was a predictor for the development of postoperative voiding dysfunction [19,20]. In our present study, none of the patients had postoperative urinary retention.…”

“…Therefore, further examinations to compare age-adjusted cQmax in patients and healthy women will solve the clinical question regarding high urinary flow in SUI patients. A correlation between low urinary flow rate and postoperative voiding dysfunction in MUS has been well discussed in several studies [17][18][19][20]. In the TOT procedure, postoperative urinary retention had no correlation with preoperative urinary [11].…”

Effect of Preoperative Low Maximal Flow Rate on Postoperative Voiding Trials after the Midurethral Sling Procedure in Women with Stress Urinary Incontinence

“…25 Kim et al found that preoperative low Qmax was not associated with postoperative retention and voiding difficulty after TOT operation. 26 In a study of Ingber et al women with severe obstructive LUTS rather had significant improvement in their symptoms after MUS procedure, and there was no subject showing retention or voiding difficulty at follow-up, implying that they can safely managed with MUS procedures. 27 For the treatment of prolonged voiding difficulty after sling procedure, various methods of sling incision have been reported with high success rates.…”

“…Kim et al. found that preoperative low Qmax was not associated with postoperative retention and voiding difficulty after TOT operation . In a study of Ingber et al.…”

Evaluation of per-operative cough stress test during transobturator mid-urethral sling surgery

“…For assessment of the mesh tension, cough stress test (CST) is used intreoperatively while TOT procedure (11). As less tension is associated with leaving the patient incontinent, more tension may cause voiding disorders (12). In this study, we evaluated affect of CST on TOT procedure success rate and patients quality of life with using the Incontinence Impact Questionnaire and Urinary Distress Inventory Questionnaire.…”