Korean J Urol.  2015 Dec;56(12):823-830. 10.4111/kju.2015.56.12.823.

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

• Ahn C
• Bae J
• Lee KS
• Lee HW

• KMID: 2359875
• DOI: http://doi.org/10.4111/kju.2015.56.12.823

Abstract

PURPOSE
The 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 METHODS
The 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.
RESULTS
Ten 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.
CONCLUSIONS
With 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.

Keyword

Suburethral slings; Urethral obstruction; Urinary incontinence; Urodynamics

MeSH Terms

Adult
Aged
Aged, 80 and over
Female
Humans
Hysterectomy/adverse effects
Middle Aged
Retrospective Studies
Risk Factors
Suburethral Slings/*adverse effects
Urinary Catheterization
Urinary Incontinence, Stress/physiopathology/*surgery
Urinary Retention/diagnosis/*etiology/physiopathology
Urodynamics

Reference

1. Schimpf MO, Rahn DD, Wheeler TL, Patel M, White AB, Orejuela FJ, et al. Sling surgery for stress urinary incontinence in women: a systematic review and metaanalysis. Am J Obstet Gynecol. 2014; 211:71.e1. 71.e27.

2. Salin A, Conquy S, Elie C, Touboul C, Parra J, Zerbib M, et al. Identification of risk factors for voiding dysfunction following TVT placement. Eur Urol. 2007; 51:782–787.

3. Hong B, Park S, Kim HS, Choo MS. Factors predictive of urinary retention after a tension-free vaginal tape procedure for female stress urinary incontinence. J Urol. 2003; 170:852–856.

4. Kim JH, Shin SH, Oh MM, Park JY, Lee JG, Bae JH. Factors affecting transient urinary retention after transobturator tape mid-urethral sling surgery for female patients with stress urinary incontinence: a single center experience. Eur J Obstet Gynecol Reprod Biol. 2013; 168:107–111.

5. Stanford EJ, Paraiso MF. A comprehensive review of suburethral sling procedure complications. J Minim Invasive Gynecol. 2008; 15:132–145.

6. Siddighi S, Karram MM. Surgical and nonsurgical approaches to treat voiding dysfunction following antiincontinence surgery. Curr Opin Obstet Gynecol. 2007; 19:490–495.

7. Albo ME, Richter HE, Brubaker L, Norton P, Kraus SR, Zimmern PE, et al. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med. 2007; 356:2143–2155.

8. Sweeney DD, Leng WW. Treatment of postoperative voiding dysfunction following incontinence surgery. Curr Urol Rep. 2005; 6:365–370.

9. Deng DY, Rutman M, Raz S, Rodriguez LV. Presentation and management of major complications of midurethral slings: are complications under-reported? Neurourol Urodyn. 2007; 26:46–52.

10. Choi YS, Kim JC, Lee KS, Seo JT, Kim HJ, Yoo TK, et al. Analysis of female voiding dysfunction: a prospective, multi-center study. Int Urol Nephrol. 2013; 45:989–994.

11. Kim S, Bae J, Cho M, Lee K, Lee H, Jun T. Effect of preoperative flow rate on postoperative retention and voiding difficulty after transobturator tape operation. Korean J Urol. 2014; 55:190–195.

12. Carr LK, Webster GD. Voiding dysfunction following incontinence surgery: diagnosis and treatment with retropubic or vaginal urethrolysis. J Urol. 1997; 157:821–823.

13. Richter HE, Albo ME, Zyczynski HM, Kenton K, Norton PA, Sirls LT, et al. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med. 2010; 362:2066–2076.

14. Wu JM, Kawasaki A, Hundley AF, Dieter AA, Myers ER, Sung VW. Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050. Am J Obstet Gynecol. 2011; 205:230.e1. 230.e5.

15. Ward K, Hilton P. United Kingdom and Ireland Tension-free Vaginal Tape Trial Group. Prospective multicentre randomised trial of tension-free vaginal tape and colposuspension as primary treatment for stress incontinence. BMJ. 2002; 325:67.

16. Morey AF, Medendorp AR, Noller MW, Mora RV, Shandera KC, Foley JP, et al. Transobturator versus transabdominal mid urethral slings: a multi-institutional comparison of obstructive voiding complications. J Urol. 2006; 175(3 Pt 1):1014–1017.

17. Ford AA, Rogerson L, Cody JD, Ogah J. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2015; 7:CD006375.

18. Sanses TV, Brubaker L, Xu Y, Kraus SR, Lowder JL, Lemack GE, et al. Preoperative hesitating urinary stream is associated with postoperative voiding dysfunction and surgical failure following Burch colposuspension or pubovaginal rectus fascial sling surgery. Int Urogynecol J. 2011; 22:713–719.

19. Celik H, Harmanlı O. Evaluation and management of voiding dysfunction after midurethral sling procedures. J Turk Ger Gynecol Assoc. 2012; 13:123–127.

20. Patel BN, Kobashi KC, Staskin D. Iatrogenic obstruction after sling surgery. Nat Rev Urol. 2012; 9:429–434.

21. Pham KN, Topp N, Guralnick ML, Koduri S, Newcomer JR, O'Connor RC. Preoperative Valsalva voiding increases the risk of urinary retention after midurethral sling placement. Int Urogynecol J. 2010; 21:1243–1246.

22. Rosenblum N, Nitti VW. Post-urethral suspension obstruction. Curr Opin Urol. 2001; 11:411–416.

23. Klutke C, Siegel S, Carlin B, Paszkiewicz E, Kirkemo A, Klutke J. Urinary retention after tension-free vaginal tape procedure: incidence and treatment. Urology. 2001; 58:697–701.

24. Jang HA, Bae JH, Lee JG. Incidence and risk factors of postoperative de novo voiding dysfunction following midurethral sling procedures. Korean J Urol. 2009; 50:762–766.

25. Mostafa A, Madhuvrata P, Abdel-Fattah M. Preoperative urodynamic predictors of short-term voiding dysfunction following a transobturator tension-free vaginal tape procedure. Int J Gynaecol Obstet. 2011; 115:49–52.

26. Houwing MM, Schulz JA, Flood CG, Baydock S, Rosychuk RJ. A retrospective review of tension-free vaginal tape/transobturator tape procedures done concomitantly with prolapse repair. J Obstet Gynaecol Can. 2013; 35:340–347.

27. Kleeman S, Goldwasser S, Vassallo B, Karram M. Predicting postoperative voiding efficiency after operation for incontinence and prolapse. Am J Obstet Gynecol. 2002; 187:49–52.

28. Miller EA, Amundsen CL, Toh KL, Flynn BJ, Webster GD. Preoperative urodynamic evaluation may predict voiding dysfunction in women undergoing pubovaginal sling. J Urol. 2003; 169:2234–2237.

29. Houwert RM, Venema PL, Aquarius AE, Bruinse HW, Kil PJ, Vervest HA. Predictive value of urodynamics on outcome after midurethral sling surgery for female stress urinary incontinence. Am J Obstet Gynecol. 2009; 200:649.e1. 649.e12.

30. Wai CY, Curto TM, Zyczynski HM, Stoddard AM, Burgio KL, Brubaker L, et al. Patient satisfaction after midurethral sling surgery for stress urinary incontinence. Obstet Gynecol. 2013; 121:1009–1016.