Predictors of Postoperative Voiding Dysfunction following Transobsturator Sling Procedures in Patients with Stress Urinary Incontinence

Abstract

Purpose:We evaluated the influence of preoperative physical examination (PE) and urodynamic study (UDS) findings on objective postoperative bladder emptying, the subjective development of bladder storage symptoms, and patient-reported success of correction of stress urinary incontinence (SUI). Materials and Methods: From January 2007 to August 2008, a total of 159 female patients with SUI underwent transobturator midurethral sling surgery (TOT). The patients were selected for SUI, with no overactive bladder (OAB) symptoms, no detrusor overactivity (DO) on UDS, no pelvic organ prolapse, and no history of prior anti-incontinence surgery. Of these patients, 128 patients (aged 38-74 years; mean age, 51.8±7.1 years) with follow-up of at least 12 months were included in the analysis. All patients had PE and UDS findings, including Q-tip testing, free maximal flow rates (Qmax), filling cystometry, Valsalva leak point pressure, detrusor pressure at maximal flow, and maximal urethral closing pressure. The primary outcome was postoperative voiding dysfunction, defined as the subjective feeling of not empting one's bladder completely and a postvoid residual ≥100 ml. A secondary outcome, "cure" of SUI, was defined as "a negative result on the cough stress test and no subjective complaint of urine leakage." We analyzed the preoperative parameters by univariate and multivariate regression for voiding dysfunction, de novo OAB, cure rate, and the patients' satisfaction. Results: Patients with a preoperative Qmax < 15 ml/s (7 patients) had a tendency for postoperative voiding dysfunction compared with those with a Qmax 15 ml/s (15 patients) (35.0% vs. 13.9%, respectively; p=0.046). No other preoperative parameters had a statistically significant influence on postoperative voiding dysfunction. Receiver operating characteristic (ROC) analysis revealed that Qmax was a good predictor because the area under the ROC curve value of Qmax was 0.81 (95% CI: 0.73 to 0.89, p<0.001). The univariate and multivariate analysis of the preoperative PE and UDS parameters demonstrated that no significant differences and no independent risk factors were related to the postoperative de novo OAB, cure rate, or the patients' satisfaction. Conclusions: These findings suggest that preoperative UDS results, especially Qmax, could be used to predict postoperative voiding dysfunction after the TOT procedure.

Evaluation and management of voiding dysfunction after midurethral sling procedures

“…Barron et al (20) reported that a Valsalva leak point pressure of more than 60 cm H 2 O and a maximum urethral closure pressure of more than 20 cm H 2 O were associated with a successful immediate voiding trial. Despite the aforementioned studies, numerous other studies have shown no association between postoperative VD and the parameters such as preoperative peak flow rate, preoperative PVR, Valsalva leak point pressureor severe intrinsic sphincter deficiency (15,18,(20)(21)(22)(23)(24). We were not able to find any report which studied the type of voiding mechanism and detrusor pressures with respect to VD after midurethral slings (25).…”

“…The mean preoperative peak flow rates in the group with and without urinary retention were 22.3 and 29.7 ml/s, respectively. Sung-Tae et al (18) suggested that a peak flow rate lower than 15 ml/s was the most predictive variable for postoperative VD. Some studies investigated the effect of preoperative residual on postoperative VD.…”

Effective parameters of urodynamic study before pelvic organ prolapse surgery and validation of concomitant surgery on urinary outcomes: Retrospective cohort study

“…Kilicarslan et al [20] noted that high VLPP was associated with better outcomes, whereas other studies have failed to prove any impacts of preoperative leak point pressures on surgical outcomes [21,22]. Other Korean doctors showed patients with preoperative Qmax<15 mL/sec had a tendency of postoperative voiding dysfunction [23]. Despite confl icting results of many studies, urodynamic study is suggested as the most accurate method for predicting surgical outcomes.…”

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

“…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].…”