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

Ripperda, Christopher M.; Kowalski, Joseph T.; Chaudhry, Zaid; Mahal, Aman S.; Lanzer, Jennifer L; Noor, Nabila; Good, Meadow M.; Hynan, Linda S.; Jeppson, Peter C.; Rahn, David D.

doi:10.1016/j.ajog.2016.06.010

Cited by 31 publications

(25 citation statements)

References 15 publications

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“…In our practice, similarly to Barisiene et al [18], we mobilised the sling within 1 week postoperatively. Ripperda et al [40] tried to identify the predictive factors of early postoperative voiding dysfunction. It seems that current medical comorbidities and an increasing postvoid residual volume during pressure-flow studies at the preoperative urodynamic assessment increase the risk of initial voiding trial failure, leading to postoperative urinary tract infections and the development of acute urinary retention.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative and early postoperative complications in women with stress urinary incontinence treated with suburethral slings: a randomised trial.

Szymański

Zaręba

Jakiel

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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Introduction: The midurethral sling has become the current standard for the treatment of female stress urinary incontinence. Aim: To assess intraoperative complications, early post-operative complications as well as the efficacy of tension-free vaginal tape: retropubic and trans-obturator tape procedures. Material and methods: The analysis involved 91 tension-free vaginal tape (TVT) and 60 transobturator tape (TOT) procedures. Both groups were comparable in terms of patient characteristics, urodynamic results, and preoperative quality of life (QoL) assessment. The complications were registered, and the effectiveness of the procedures was assessed subjectively by the patients at 1-, 3-, 6-and 12-month follow-up. Results: A significantly lower risk of intraoperative and early post-operative complications was noted in the case of TOT procedures (OR = 0.35%, 95% CI: 0.13-0.92). Moreover, regardless of the method used, patients with two or more vaginal deliveries in their history had a reduced risk of complications, as compared to nulliparas and uniparas (OR = 0.38%, 95% CI: 0.16-0.91). Previous gynaecological surgery and old age increase the risk of complications with borderline significance (OR = 2.5, 95% CI: 0.97-6.3; OR = 2.3, 95% CI: 0.95-5.5 respectively). The rates of cure, improvement and failure were similar in both groups, as was the significant positive change in post-operative life quality. Conclusions: TVT and TOT procedures are characterised by a high cure rate and improvement in the post-operative quality of life. However, it seems that the transobturator approach should be the preferred method of treatment of SUI due to the reduced risk of complications, shorter procedure time, and lower intraoperative blood loss.

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Section: Discussionmentioning

confidence: 99%

Intraoperative and early postoperative complications in women with stress urinary incontinence treated with suburethral slings: a randomised trial.

Szymański

Zaręba

Jakiel

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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“…In the context of the baseline characteristics of patients receiving scopolamine, one might expect the findings of this study to be reversed—that patients without scopolamine use would have a higher rate of retention. Specifically, older age and comorbidities have been linked to voiding dysfunction following MUS 1,5 . The fact that younger and healthier patients in the treatment group had more voiding dysfunction postoperatively seemingly strengthens the association of scopolamine with PUR.…”

Section: Discussionmentioning

confidence: 87%

“…Many studies have investigated patient‐related factors that influence the likelihood of PUR. These include preoperative uroflowmetry parameters, such as elevated postvoid residual (PVR) and low maximal flow rate; concomitant prolapse surgery or history of prolapse surgery; elevated body mass index (BMI); and advanced age 1,2,4,5 . Notably, all of these factors are out of the control of the surgeon.…”

Section: Introductionmentioning

confidence: 99%

The role of perioperative medications in urinary retention following midurethral sling

Katz

Stensland

Alazem

et al. 2020

Neurourology and Urodynamics

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Aims: Postoperative urinary retention (PUR) is a known complication of midurethral sling (MUS) placement. The use of certain perioperative medications may influence the risk of this complication. This study aimed to investigate the association of perioperative medications with urinary retention after MUS. Methods: This was a retrospective study of women undergoing MUS placement for stress urinary incontinence by a fellowship-trained urologic surgeon between 2015 and 2018, under approval by the Institutional Review Board. Both retropubic and transobturator approaches were included. All patients underwent an active void trial following surgery. Intraoperative medications given by the anesthesia team were retrospectively noted. The Fisher's exact test was used to compare the association of PUR with categorical variables. Results: A total of 82 patients were included, 17 (21%) of whom failed postoperative void trial due to urinary retention. Of 25 patients receiving perioperative scopolamine, 40% failed the postoperative void trial, compared to 12% of patients not receiving scopolamine (p = .048). Groups were then stratified based on scopolamine use due to the observed independent association with PUR. Subgroup analysis revealed a stronger association of postoperative retention with scopolamine in patients undergoing concomitant prolapse surgery. Notably, retention rate and scopolamine use were similar whether patients underwent sling placement alone or in combination with prolapse surgery. Rate of retention was also higher for retropubic versus transobturator slings (36% vs. 9%; p = .005). Conclusions: Perioperative scopolamine may be associated with an increased risk of postoperative urinary retention following MUS, especially in the setting of a concomitant prolapse surgery.

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“…This was also the case in our study group. Others observed that the main significant risk factor for the development of LUTS after MUS surgery was a preoperative peak urinary flow rate < 20 ml/s [ 7 ], as well as an increased preoperative value of postvoid residual, with no difference in voiding trial failures between retropubic and transobturator groups [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Transobturator midurethral sling: What should patients expect after surgery?

et al. 2017

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Introduction and hypothesisMidurethral sling (MUS) surgeries are minimally invasive procedures; however, they are not free of postoperative complications. The aim of the study was to assess the occurrence of lower urinary tract symptoms (LUTS) (urgency, nocturia, frequency, splitting/spraying, hesitancy, terminal dribbling, and subjective feeling of postvoid residual) in patients suffering from stress (SUI) or mixed (MUI) urinary incontinence with a predominant SUI component before and after transobturator MUS placement.MethodsThe study group consisted of 88 women with SUI and 18 with MUI who underwent transobturator MUS. All participants were questioned with a self-developed questionnaire before and after surgery regarding the presence of LUTS.ResultsSeven days after surgery, 62 patients (58.5%) noted voiding and postmicturition symptoms, whereas 67 (63.2%) reported problems in storage. The more commonly reported LUTS at week 1 after surgery were urgency (52.8%), splitting/spraying (41.5%), and feeling of incomplete bladder emptying (34.0%). Patients perceived that splitting/spraying was the most bothersome. After 6 months, the most common LUTS reported were hesitancy (14.1%), terminal dribbling (10.4%), and splitting/spraying (9.4%). We noticed a decrease in the number of urgency episodes >2.7 times (p < 0.001) compared with baseline. After 6 months, 97 (91.5%) patients reported the lack of incontinence episodes.ConclusionsA vast majority of patients after MUS suffer from LUTS in the early postoperative period; however, the majority of undesired symptoms resolve spontaneously within the first 6 months postsurgery.

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

Cited by 31 publications

References 15 publications

Intraoperative and early postoperative complications in women with stress urinary incontinence treated with suburethral slings: a randomised trial.

Intraoperative and early postoperative complications in women with stress urinary incontinence treated with suburethral slings: a randomised trial.

The role of perioperative medications in urinary retention following midurethral sling

Transobturator midurethral sling: What should patients expect after surgery?

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