Predicting early voiding dysfunction after tension-free vaginal tape

Abstract

The purpose of this study was to determine whether early postoperative voiding dysfunction can be predicted before inserting a tension-free vaginal tape (TVT). Multiple parameters including demographic data, history of previous anti-incontinence surgery, anaesthetic type, operator experience, type of surgical procedure (TVT alone or combined with other prolapse surgery) and preoperative urodynamic studies were analysed by univariate analysis and stepwise multiple logistic regression. The data from 500 women were prospectively collected. Early voiding dysfunction occurred in 5.8% of women postoperatively. Using stepwise multiple logistic regression, voiding by other than a detrusor contraction (p = 0.02), preoperative pressure flow rate <15 ml/s (p = 0.04) and general anaesthesia (p = 0.02) were the only factors that predicted early postoperative voiding dysfunction. The point estimate relative risks were 5.6, 11.6 and 4.4 and the positive predicting values were 11.4%, 11.8% and 16.1%, respectively. Despite statistically significant associations with early voiding dysfunction, the positive predictive values of the identified factors remain low, limiting the accurate prediction of early voiding dysfunction.

Incidence and treatment of postoperative voiding dysfunction after the tension-free vaginal tape procedure

“…Their study showed a strong association between VD and concomitant prolapse surgery. Duckett et al [14] performed a retrospective study on 500 TVT patients. They found VD in 5.8 %, which concurred with our results of 4 %.…”

Voiding Dysfunction after the Tension-Free Vaginal Tape Procedure

“…The studies with the focus on surgical management of voiding dysfunction determined a proportion of surgical intervention because of urinary retention from 1.7 to 11% (table 3). Various factors were shown to be associated with postoperative voiding difficulties, including the age of the patient [20,21,22], abnormal preoperative uroflow pattern [20,21,23,24], general anesthesia [23], previous incontinence surgery [21], an inexperienced surgeon [8], recurrent surgery [19], concurrent vault suspension surgery [7], and postoperative urinary tract infection [7]. Other authors do not corroborate these risk factors [10,25].…”

Effect of anesthesia type on perioperative outcomes with a midurethral sling

“…While several studies have evaluated the effect of anesthesia in the placement of midurethral slings, none has directly compared GA with MAC [12][13][14][15]. One randomized controlled trial of women undergoing minislings with Gynecare TVT-Secur TM compared local anesthesia with intravenous sedation (lidocaine with midazolam/fentanyl) with GA and found a higher level of pain 1 h postoperatively and longer recovery time in the GA group [12].…”