Predictors of Success With Postoperative Voiding Trials After a Mid Urethral Sling Procedure

Wheeler, Thomas L.; Richter, Holly E.; Greer, W. Jerod; Bowling, C. Bryce; Redden, David T.; Varner, R. Edward

doi:10.1016/j.juro.2007.09.080

Cited by 45 publications

(20 citation statements)

References 18 publications

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“…In this study, abnormal uroflowmetry, which was defined as flow that did not have a normal configuration or pattern, was found to be an associated factor. A prospective trial of 89 women who underwent the midurethral sling procedure showed low peak flow rate to be the only independent variable for a successful initial voiding trial (16). This is consistent with another retrospective study of 375 patients by Hong et al (17), which also found lower preoperative peak flow rates as a risk factor.…”

Section: Urodynamic Parameterssupporting

confidence: 79%

Evaluation and management of voiding dysfunction after midurethral sling procedures

Çelik

Harmanli

2012

J Turkish German Gynecol Assoc

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Section: Urodynamic Parameterssupporting

confidence: 79%

Evaluation and management of voiding dysfunction after midurethral sling procedures

Çelik

Harmanli

2012

J Turkish German Gynecol Assoc

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“…However, these studies focused on the initial event of voiding dysfunction, whereas both in the study by Wheeler et al [3] and in the present study, voiding dysfunction developed in a significant proportion of patients who had passed the first voiding trial. The study by Wheeler et al [3] showed that 16.4% of patients who passed the initial voiding trial failed on the second.…”

Section: Discussionmentioning

confidence: 56%

“…Temporary voiding dysfunction manifests as transient urinary retention or incomplete bladder emptying, which may require prolonged or intermittent catheterization and is associated with an increased risk of urinary tract infection and patient inconvenience [3]. …”

Section: Introductionmentioning

confidence: 99%

“…Commonly, objective or subjective preoperative variables from the patient history and urodynamic variables that may predict the possibility of low bladder functionality have been the focus of investigation [1,2,4,5]. However, recent studies have also shown that single estimation of postoperative voiding function is not reliable in predicting maintenance of good functionality and that such preoperative factors do not necessarily ensure against subsequent successful voids [3]. …”

Section: Introductionmentioning

confidence: 99%

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Predictors of Voiding Dysfunction after Mid-urethral Sling Surgery for Stress Urinary Incontinence

et al. 2012

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PurposePostoperative voiding dysfunction is a bothersome complication after mid-urethral sling surgery. The current study presents multiple repeated postoperative voiding trials against a urine load of preoperative functional bladder capacity, as estimated by a preoperative frequency volume chart, to identify the relevance of preoperative and immediate factors to the outcome.MethodsA total of 180 patients were enrolled from August 2008 to August 2011. Patients received mid-urethral sling surgery with a transobturator tape, with or without concomitant cystocele repair. Patients reported relevant medical histories and a 3-day frequency volume chart and underwent urodynamic studies. After surgery, patients were filled to their maximum bladder capacity as dictated by their frequency volume chart and performed the first voiding trial. Two subsequent voiding trials were performed after natural filling. Failure of any single voiding trial was considered failure. Patients who failed the final voiding trial received intermittent catheterization to follow-up. After screening for relevant factors with the use of univariate analyses, preoperative, surgical, and postoperative factors predicting outcome were estimated by logistic regression analysis.ResultsThe urine load at the voiding trial and the peak flow rate immediately preceding the voiding trial predicted voiding trial success in the multivariate analysis. Urine load and previous trial peak flow rate were relevant when tested against each individual voiding trial. Preoperative and surgical factors, such as age, parity, and concomitant cystocele repair, showed significance in the univariate analysis. Overall, 16.1% of patients who passed the first voiding trial failed on subsequent trials, whereas 36.8% of patients who failed the first voiding trial succeeded.ConclusionsPostoperative voiding dysfunction is transient and is associated with the immediate voiding conditions following surgery. Close observation against urine overload in the bladder is important when weaning patients back to normal voiding conditions.

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“…Slings that are too loose may still allow stress incontinence. Although most urinary retention resolves with conservative treatment, including medication, urethral dilation, or intermittent catheterization, refractory urethral obstruction ultimately requires midline or lateral excision of the tape [22]. If SUI reappears or the patient suffers persistence of urinary leakage after surgery, we will need to perform a new intervention to correct it.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of the Clinical Efficacy of the Transobturator Adjustable Tape (TOA) and Transobturator Tape (TOT) for Treating Female Stress Urinary Incontinence with Intrinsic Sphincter Deficiency: Short-term Results

Shin

2012

Korean J Urol

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PurposeThe transobturator adjustable tape (TOA) allows adjustment of tension after surgical intervention, thus permitting correction of postoperative incontinence or obstruction. The aim of this study was to compare the efficacy and safety of TOA versus transobturator tape (TOT) for the treatment of stress urinary incontinence with intrinsic sphincter deficiency (ISD).Materials and MethodsPatients underwent TOA (n=33 with ISD) or TOT (n=47 with ISD) insertion by one experienced surgeon. The patients were considered to have ISD on the basis of a Valsalva leak point pressure <60 cmH2O or a maximum urethral closure pressure <20 cmH2O. The preoperative evaluation included history taking, physical examination, voiding diary, stress and 1-hour pad tests, and a comprehensive urodynamic examination. Postoperative evaluation included a stress test, 1-hour pad test, questionnaire, and uroflowmetry with postvoid residuals.ResultsAfter 6 months of follow-up, the rate of cure (TOA, 75.6% vs. TOT, 72.3%) was similar between the two groups. The rate of satisfaction was not significantly higher in the TOA group than in the TOT group (84.8% vs. 78.7%; p=0.05). Four patients in the TOA group (12.1%) needed a reduction in tension because of urinary obstruction (flow <10 ml/sec and/or residual urine >50 ml). The tension of the mesh was tightened in 5 patients (15.2%) because of the persistence of a certain degree of incontinence. The residual urine volume at postoperative 7 days was significantly lower in the TOA group than in the TOT group (19.5 ml vs. 41 ml; p=0.016, repeated-measures analysis of variance test).ConclusionsThe TOA allows postoperative readjustment of the suburethral sling pressure for a number of days after surgical intervention, which allows for the achievement of good short-term results. These data suggest that better lower obstructive voiding symptoms than those achieved with the traditional nonadjustable mesh can be obtained with the TOA.

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Predictors of Success With Postoperative Voiding Trials After a Mid Urethral Sling Procedure

Cited by 45 publications

References 18 publications

Evaluation and management of voiding dysfunction after midurethral sling procedures

Evaluation and management of voiding dysfunction after midurethral sling procedures

Predictors of Voiding Dysfunction after Mid-urethral Sling Surgery for Stress Urinary Incontinence

A Comparison of the Clinical Efficacy of the Transobturator Adjustable Tape (TOA) and Transobturator Tape (TOT) for Treating Female Stress Urinary Incontinence with Intrinsic Sphincter Deficiency: Short-term Results

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