Predictors of early postoperative voiding dysfunction and other complications following a midurethral sling

• Published in: American journal of obstetrics and gynecology 2016-11, Vol.215 (5), p.656.e1-656.e6
• Main Authors: Ripperda, Christopher M., MD, Kowalski, Joseph T., MD, Chaudhry, Zaid Q., MD, Mahal, Aman S., MD, Lanzer, Jennifer, MD, Noor, Nabila, MD, Good, Meadow M., DO, Hynan, Linda S., PhD, Jeppson, Peter C., MD, Rahn, David D., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Case-Control Studies; early postoperative complications; Female; Follow-Up Studies; Humans; Logistic Models; Middle Aged; midurethral sling; Multivariate Analysis; Obstetrics and Gynecology; Postoperative Complications - etiology; Preoperative Period; Retrospective Studies; Suburethral Slings; Treatment Outcome; Urinary Incontinence, Stress - surgery; Urination Disorders - diagnosis; Urination Disorders - etiology; Urination Disorders - surgery; voiding dysfunction; Young Adult
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2016.06.010

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%