Predictive factors for voiding dysfunction after transobturator slings

Abstract

Objective: The aim of this study was to identify predictive factors for voiding dysfunction after transobturator slings. Background: Suburethral slings are now the most widely performed surgical procedures for the treatment of stress urinary incontinence. The transobturator (TOT) approach has been shown to be a safer and less morbid surgery with favorable outcomes. Voiding dysfuction after incontinence surgery is a potential complication of all stress incontinence procedures. Identifying preoperative predictive factors to voiding dysfunction is important to advise patients about their individual risk of this complication. Previous works associate voiding dysfunction post anti-incontinence surgery with increased age, irritative bladder symptoms, previous genital prolapse, previous incontinence and/or prolpase surgery and urodynamic finding of reduced peak voiding flow rates. Material and methods: We retrospectively reviewed the records of all patients who underwent a transobturator sling at our Institution. Between March 2003 and December 2008, 514 women had available data with at least 6-week follow up. Patients' demographics, preoperative symptoms, urodynamics including multichannel voiding studies and surgical variables were tabulated. Univariate analysis was performed with respect to postoperative voiding dysfunction. It was defined by a catheterized or ultrasonographic postvoid residual greater than 100 Cm3 (>6 weeks after the procedure) associated with any complaint of abnormal voiding (irregular stream, sense of incomplete emptyn, invreasing urgency and frequency). Results: Our patient population had a mean age of 58.5 years (23.8- 92.9). We identified 33 out of 514 patients (6.4%) with voiding dysfunction according our definition. No differences were noted between normal and dysfunctional voiders in age, associate prolapse surgery and preoperative post void residual. Flow rate, prior surgeries and menopausal status were not predictive of voiding dysfunction in our analysis. Valsalva effort during the preoperative pressure flow study was the only predictive factor for voiding dysfunction, 72.4% in dysfunctional group vs. 27.6% normal (p<0.001). Conclusion: The urodynamic finding of valsalva maneuver during the micturition is routinely assessed, readily available and according with our study, could identify those women at risk for voiding dysfunction after transobturator sling. We suggest this factor should be noted and considered during pre-operative counseling. (Table presented) .