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Predictors of early postoperative voiding dysfunction and other complications following a midurethral sling.
Am J Obstet Gynecol. 2016 Nov; 215(5):656.e1-656.e6.AJ

Abstract

BACKGROUND

The rates reported for postoperative urinary retention following midurethral sling procedures are highly variable. Determining which patients have a higher likelihood of failing a voiding trial will help with preoperative counseling prior to a midurethral sling.

OBJECTIVE

The objective of the study was to identify preoperative predictors for failed voiding trial following an isolated midurethral sling.

STUDY DESIGN

A retrospective, multicenter, case-control study was performed by including all isolated midurethral sling procedures performed between Jan. 1, 2010 to June 30, 2015, at 6 academic centers. We collected demographics, medical and surgical histories, voiding symptoms, urodynamic evaluation, and intraoperative data from the medical record. We excluded patients not eligible for attempted voiding trial after surgery (eg, bladder perforation requiring catheterization). Cases failed a postoperative voiding trial and were discharged with an indwelling catheter or taught intermittent self-catheterization; controls passed a voiding trial. We also recorded any adverse events such as urinary tract infection or voiding dysfunction up to 6 weeks after surgery. Bivariate analyses were completed using Mann-Whitney and Pearson χ2 tests as appropriate. Multivariable stepwise logistic regression was used to determine predictors of failing a voiding trial.

RESULTS

A total of 464 patients had an isolated sling (70.9% retropubic, 28.4% transobturator, 0.6% single incision); 101 (21.8%) failed the initial voiding trial. At follow-up visits, 90.4% passed a second voiding trial, and 38.5% of the remainder passed on the third attempt. For the bivariate analyses, prior prolapse or incontinence surgery was similar in cases vs controls (31% vs 28%, P = .610) as were age, race, body mass index, and operative time. Significantly more of the cases (32%) than controls (22%) had a Charlson comorbidity index score of 1 or greater (P = .039). Overactive bladder symptoms of urgency, frequency, and urgency incontinence were similar in both groups as was detrusor overactivity in those with a urodynamic evaluation (29% vs 22%, P = .136), but nocturia was reported more in the cases (50% vs 38%, P = .046). Mean (SD) bladder capacity was similar in both groups (406 [148] mL vs 388 [122] mL, P = .542) as was maximum flow rate with uroflowmetry and pressure flow studies. Cases were significantly more likely to have a voiding type other than detrusor contraction: 37% vs 25%, P = .027, odds ratio, 1.79 (95% confidence interval, 1.07-3.00). There was no difference in voiding trial failures between retropubic and transobturator routes (23.1% vs 18.9%, P = .329). Within 6 weeks of surgery, the frequency of urinary tract infection in cases was greater than controls (20% vs 6%, P < .001; odds ratio, 3.51 [95% confidence interval, 1.82-6.75]). After passing a repeat voiding trial, cases were more likely to present with acute urinary retention (10% vs 3%, P = .003; odds ratio, 4.00 [95% confidence interval, 1.61-9.92]). For multivariable analyses, increasing Charlson comorbidity index increased the risk of a voiding trial failure; apart from this, we did not identify other demographic information among the patients who did not undergo urodynamic evaluation that reliably forecasted a voiding trial failure.

CONCLUSION

The majority of women will pass a voiding trial on the first attempt after an isolated midurethral sling. Current medical comorbidities are predictive of a voiding trial failure, whereas other demographic/examination findings are not. Patients failing the initial voiding trial are at an increased risk of postoperative urinary tract infection or developing acute retention after passing a subsequent voiding trial.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: Christopher.Ripperda@utsouthwestern.edu.Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA.Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA.Department of Obstetrics and Gynecology, Stanford University, Palo Alto, CA.Department of Gynecology and Obstetrics, Emory University, Atlanta, GA.Department of Obstetrics and Gynecology, Mount Auburn Hospital/Harvard Medical School, Cambridge, MA.Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.Department of Clinical Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX.Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM.Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

27319367

Citation

Ripperda, Christopher M., et al. "Predictors of Early Postoperative Voiding Dysfunction and Other Complications Following a Midurethral Sling." American Journal of Obstetrics and Gynecology, vol. 215, no. 5, 2016, pp. 656.e1-656.e6.
Ripperda CM, Kowalski JT, Chaudhry ZQ, et al. Predictors of early postoperative voiding dysfunction and other complications following a midurethral sling. Am J Obstet Gynecol. 2016;215(5):656.e1-656.e6.
Ripperda, C. M., Kowalski, J. T., Chaudhry, Z. Q., Mahal, A. S., Lanzer, J., Noor, N., Good, M. M., Hynan, L. S., Jeppson, P. C., & Rahn, D. D. (2016). Predictors of early postoperative voiding dysfunction and other complications following a midurethral sling. American Journal of Obstetrics and Gynecology, 215(5), e1-e6. https://doi.org/10.1016/j.ajog.2016.06.010
Ripperda CM, et al. Predictors of Early Postoperative Voiding Dysfunction and Other Complications Following a Midurethral Sling. Am J Obstet Gynecol. 2016;215(5):656.e1-656.e6. PubMed PMID: 27319367.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of early postoperative voiding dysfunction and other complications following a midurethral sling. AU - Ripperda,Christopher M, AU - Kowalski,Joseph T, AU - Chaudhry,Zaid Q, AU - Mahal,Aman S, AU - Lanzer,Jennifer, AU - Noor,Nabila, AU - Good,Meadow M, AU - Hynan,Linda S, AU - Jeppson,Peter C, AU - Rahn,David D, Y1 - 2016/06/16/ PY - 2016/01/05/received PY - 2016/05/20/revised PY - 2016/06/07/accepted PY - 2016/10/30/pubmed PY - 2017/6/1/medline PY - 2016/6/21/entrez KW - early postoperative complications KW - midurethral sling KW - voiding dysfunction SP - 656.e1 EP - 656.e6 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 215 IS - 5 N2 - BACKGROUND: The rates reported for postoperative urinary retention following midurethral sling procedures are highly variable. Determining which patients have a higher likelihood of failing a voiding trial will help with preoperative counseling prior to a midurethral sling. OBJECTIVE: The objective of the study was to identify preoperative predictors for failed voiding trial following an isolated midurethral sling. STUDY DESIGN: A retrospective, multicenter, case-control study was performed by including all isolated midurethral sling procedures performed between Jan. 1, 2010 to June 30, 2015, at 6 academic centers. We collected demographics, medical and surgical histories, voiding symptoms, urodynamic evaluation, and intraoperative data from the medical record. We excluded patients not eligible for attempted voiding trial after surgery (eg, bladder perforation requiring catheterization). Cases failed a postoperative voiding trial and were discharged with an indwelling catheter or taught intermittent self-catheterization; controls passed a voiding trial. We also recorded any adverse events such as urinary tract infection or voiding dysfunction up to 6 weeks after surgery. Bivariate analyses were completed using Mann-Whitney and Pearson χ2 tests as appropriate. Multivariable stepwise logistic regression was used to determine predictors of failing a voiding trial. RESULTS: A total of 464 patients had an isolated sling (70.9% retropubic, 28.4% transobturator, 0.6% single incision); 101 (21.8%) failed the initial voiding trial. At follow-up visits, 90.4% passed a second voiding trial, and 38.5% of the remainder passed on the third attempt. For the bivariate analyses, prior prolapse or incontinence surgery was similar in cases vs controls (31% vs 28%, P = .610) as were age, race, body mass index, and operative time. Significantly more of the cases (32%) than controls (22%) had a Charlson comorbidity index score of 1 or greater (P = .039). Overactive bladder symptoms of urgency, frequency, and urgency incontinence were similar in both groups as was detrusor overactivity in those with a urodynamic evaluation (29% vs 22%, P = .136), but nocturia was reported more in the cases (50% vs 38%, P = .046). Mean (SD) bladder capacity was similar in both groups (406 [148] mL vs 388 [122] mL, P = .542) as was maximum flow rate with uroflowmetry and pressure flow studies. Cases were significantly more likely to have a voiding type other than detrusor contraction: 37% vs 25%, P = .027, odds ratio, 1.79 (95% confidence interval, 1.07-3.00). There was no difference in voiding trial failures between retropubic and transobturator routes (23.1% vs 18.9%, P = .329). Within 6 weeks of surgery, the frequency of urinary tract infection in cases was greater than controls (20% vs 6%, P < .001; odds ratio, 3.51 [95% confidence interval, 1.82-6.75]). After passing a repeat voiding trial, cases were more likely to present with acute urinary retention (10% vs 3%, P = .003; odds ratio, 4.00 [95% confidence interval, 1.61-9.92]). For multivariable analyses, increasing Charlson comorbidity index increased the risk of a voiding trial failure; apart from this, we did not identify other demographic information among the patients who did not undergo urodynamic evaluation that reliably forecasted a voiding trial failure. CONCLUSION: The majority of women will pass a voiding trial on the first attempt after an isolated midurethral sling. Current medical comorbidities are predictive of a voiding trial failure, whereas other demographic/examination findings are not. Patients failing the initial voiding trial are at an increased risk of postoperative urinary tract infection or developing acute retention after passing a subsequent voiding trial. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/27319367/Predictors_of_early_postoperative_voiding_dysfunction_and_other_complications_following_a_midurethral_sling_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(16)30338-6 DB - PRIME DP - Unbound Medicine ER -