Assessment of urinary dysfunction following midurethral sling placement: A comparison of two voiding trial methods

Authors

Angela Leffelman, Female Pelvic Medicine and Reconstructive Surgery (FPMRS), Division of Urogynecology, University of Chicago, Northshore University HealthSystem, Skokie, IL, USA.
Henry H. Chill, Female Pelvic Medicine and Reconstructive Surgery (FPMRS), Division of Urogynecology, University of Chicago, Northshore University HealthSystem, Skokie, IL, USA; Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel. Electronic address: henchill@gmail.com.
Ayesha Kar, Department of Obstetrics and Gynecology, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA.
Sonia Gilani, Advocate Health - MidwestFollow
Cecilia Chang, NorthShore University HealthSystem Research Institute, Evanston, IL, USA.
Roger P. Goldberg, Female Pelvic Medicine and Reconstructive Surgery (FPMRS), Division of Urogynecology, University of Chicago, Northshore University HealthSystem, Skokie, IL, USA.
Ghazaleh Rostaminia, Female Pelvic Medicine and Reconstructive Surgery (FPMRS), Division of Urogynecology, University of Chicago, Northshore University HealthSystem, Skokie, IL, USA.

Recommended Citation

Leffelman A, Chill HH, Kar A, et al. Assessment of urinary dysfunction following midurethral sling placement: a comparison of two voiding trial methods. J Minim Invasive Gynecol. Published online April 4, 2024. doi:10.1016/j.jmig.2024.04.003

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Study objective:Temporary urinary retention after midurethral sling (MUS) surgery requiring indwelling catheter or self-catheterization usage is common. Different methods for assessment of immediate postoperative urinary retention have been described. The aim of this study was to compare postoperative voiding trial (VT) success following active versus passive voiding trial in women undergoing MUS surgery.

Design:Comparative retrospective cohort study.

Setting:Female pelvic medicine and reconstructive surgery practice at a university affiliated tertiary medical center.

Patients:Patients with stress urinary incontinence who underwent surgical treatment during the study period were eligible for inclusion. Excluded were patients under the age of 18, combined cases with other surgical services, planned laparotomy, patients with history of urinary retention and patients for whom their VT was performed on postoperative day 1. The cohort was divided into two groups: 1) patients who underwent an active retrofill of their bladder using a Foley catheter; 2) patients who were allowed to have a spontaneous void.

Interventions:none.

Measurements and main results:Two hundred and eighty-five patients met the inclusion criteria for the study. Of these subjects, 94 underwent an active voiding trial and 191 underwent a passive voiding trial. There were no statistically significant differences in immediate postoperative urinary retention (30.8% vs. 29.3%, p=0.79) or time from surgery end to voiding trial (233.0 ± 167.6 minutes vs. 203.1 ± 147.8 minutes, p=0.13) between groups. Urinary retention, as defined by a failed voiding trial, increased from 10% to 29.3% when MUS placement was accompanied by concomitant prolapse repair procedure. Multivariate logistic regression analysis revealed that undergoing a combined anterior and posterior colporrhaphy (OR 5.13, p <0.001) as well as undergoing an apical prolapse procedure (OR 2.75, p=0.004) were independently associated with immediate postoperative urinary retention while increased BMI (OR 0.89, p<0.001) lowered likelihood of retention.

Conclusion:The method used to assess immediate postoperative urinary retention did not affect VT success. Concomitant combined anterior and posterior colporrhaphy and apical suspension were correlated with greater likelihood of VT failure while increased BMI decreased odds of retention.

Type

Article

PubMed ID

38582258