Effect of Preoperative Voiding Mechanism on Success Rate of Autologous Rectus Fascia Suburethral Sling Procedure

Iglesia, Cheryl B.; Shott, Susan; Fenner, Dee E.; Brubaker, Linda

doi:10.1097/00006250-199804000-00018

Cited by 8 publications

(15 citation statements)

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“…Patients who had PVR more than 100 mL ( P < 0.05) or Qmax in free UFM 20 mL/s or less ( P = 0.09) in preoperative urodynamics were more likely to require prolonged intermittent self‐catheterization after pubovaginal sling surgery. Previous papers reported several risk factors for postoperative urinary retention and the delayed return of efficient voiding that included weak detrusor 9 or preoperative Valsalva maneuver during voiding 10 . Other factors, such as age over 65 years, additional surgical procedures and low Qmax in UFM are also risk factors for delayed voiding 8 .…”

Section: Discussionmentioning

confidence: 99%

“…These complications may be attributed to the increased urethral closure pressure by the pubovaginal sling. So far, only a few papers have addressed the role of preoperative urodynamic parameters as a predictor of voiding dysfunction after the surgery 8–10 . It is important to identify preoperative risk factors and to counsel patients about the expected length of postoperative urinary drainage and the type of drainage to be used when obtaining the patient's consent.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and urodynamic outcomes of pubovaginal sling procedure with autologous rectus fascia for stress urinary incontinence

et al. 2007

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Aim:We report the clinical and urodynamic outcomes of the pubovaginal sling procedure with autologous rectus fascia for stress urinary incontinence (SUI) and determined the urodynamic parameters that could predict the occurrence of postoperative voiding difficulty. Methods: Between 1998 and 2005, a total of 29 consecutive women with SUI underwent pubovaginal sling surgery with autologous rectus fascia. Patients were preoperatively and postoperatively evaluated with regard to symptoms and urodynamic findings including uroflowmetry (UFM), postvoid residual urine volume (PVR), filling cystometry (CMG) and pressure flow study (PFS). Results: Overall SUI was cured in 23 patients (80%) and improved in 3 patients (10%). Three patients (10%) who developed persistent urinary retention or severe voiding difficulty after surgery underwent urethrolysis. Of 17 patients who had urgency before the pubovaginal sling, urgency was cured postoperatively in seven, while de novo urgency appeared in one patient. Maximum flow rate (Qmax) in UFM was significantly decreased (P < 0.05) and PVR was increased (P = 0.08) after surgery. PFS showed a significant increase in detrusor opening pressure and detrusor pressure at Qmax (P < 0.01) after surgery. Eight patients (28%) needed prolonged intermittent self-catheterization. Patients who had PVR >100 mL (P < 0.05) or Qmax Յ20 mL/s (P = 0.09) in preoperative UFM were more likely to require prolonged intermittent catheterization after surgery. Conclusions:The pubovaginal sling procedure with autologous rectus fascia is an effective treatment for SUI. A comparison of preoperative and postoperative urodynamic parameters indicates an increase in urethral resistance after pubovaginal sling surgery. PVR >100 mL and Qmax Յ20 mL/s before surgery are risk factors for postoperative voiding difficulty.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical and urodynamic outcomes of pubovaginal sling procedure with autologous rectus fascia for stress urinary incontinence

et al. 2007

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“…Higher rates of voiding dysfunction have been demonstrated in autologous fascia PVS patients who were dependent on Valsalva manoeuvre to void preoperatively by Iglesia et al. Therefore, our study only included women who voided from detrusor contractions confirmed on UDS.…”

Section: Discussionmentioning

confidence: 99%

Optimising the tension of an autologous fascia pubovaginal sling to minimize retentive complications

Preece

Chan

O’Connell

et al. 2019

Neurourology and Urodynamics

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Aim To determine the optimal degree of pubovaginal slings (PVS) tension, measured by lax sling dimensions to minimize the risk of urinary retention. Methods This prospective study analyzed female patients undergoing PVS for stress urinary incontinence (SUI) by two surgeons over 24 months from January 2016. Intra‐operative measurements of lax sling dimensions tented over rectus fascia were recorded. Logistic regression was used to analyse the likelihood of urinary retention (more than 3 months of intermittent self‐catheterisation (ISC) or surgical revision) for given PVS dimensions. The secondary analysis assessed for an association between PVS measurements and persistent SUI. Results Fifty‐one patients were recruited with a median age of 53 (34‐78) and follow‐up of 11 (3‐20) months. All but one patient reported improvement of SUI. Ten (19.6%) patients developed postoperative urinary retention. Five (9.8%) resolved after a temporary period of ISC. The other five (9.8%) required ongoing ISC or sling division. A strong association existed between short sling height and prolonged urinary retention (P = 0.00). Receiver operating characteristic (ROC) curve analysis showed a sling height of 40 mm had a sensitivity of 100% and specificity of 51% for retentive complications (area under curve [AUC] = 0.90). Lax sling height up to 60 mm was not associated with persistent SUI. Conclusions Stretching the sling suspension sutures at least 40 mm above the rectus fascia was associated with a lower risk of urinary retention than less than 40 mm. This simple technique would appear to be worth evaluating in a larger sample. A looser sling did not compromise the cure of SUI at a mean follow‐up of 11 months.

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“…Iglesia et al and Miller et al have shown that despite the high efficacy of pubovaginal sling; patients who preoperatively are valsalva voiders or have a weak detrusor contraction are at risk for urinary retention and have a higher failure rate [10,11]. Bhatia et al also showed that women undergoing Burch procedure with preoperative detrusor underactivity or valsalva voiding were 12 times more likely to require prolong postoperative urinary catheterization [9].…”

Section: Discussionmentioning

confidence: 99%

“…Some experts believe that preoperative voiding patterns can be closely related to voiding dysfunctions postoperatively [7]. Some of these voiding dysfunction has historically been explained by preoperative detrusor underactivity or valsalva straining [8][9][10][11]. Some of these voiding dysfunction has historically been explained by preoperative detrusor underactivity or valsalva straining [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Impaired Detrusor Contractility and the Treatment of Female Stress Urinary Incontinence

Sathyamoorthy¹

2014

Gynecol Obstet

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Introduction and hypothesis:Little conclusive data exists regarding Urodynamic (UD) variables predictive of voiding dysfunction after synthetic Midurethral Sling (MUS) placement. This study aims to evaluate outcomes of MUS in female patients with Impaired Detrusor Contractility (IDC), Valsalva Voiding (VV), or both. We propose that there would be no direct relationship between these variables and urinary retention requiring Clean Intermittent Catheterization (CIC) or reoperation at 6 wk follow up.Methods: Retrospective chart review was performed for all MUS procedures at a single institution, 1/2010present. Subjects with complete pre-operative UD records and 6 wk follow up were included. The primary outcome measure was urinary retention requiring CIC or re-operation at 6 wk follow up.Results: 187 women who underwent MUS from January 2010 to present had complete UD and ≥ 6 wk follow up data. Average age was 56.7 years. Pre-operative UD identified 64 (34.2%) IDC subjects. At 6-wk follow up, no new subjects in this group required CIC for obstruction or reoperation. No subjects without IDC required CIC or reoperation for urinary retention; however there were 2 reoperations in this group: persistent stress incontinence and vaginal extrusion. Pre-operative UD identified 50 (26.7%) VV subjects. One patient in this group required reoperation; however sling removal was for vaginal extrusion. In the group with both IDC and VV (n=23) no subjects required reoperation. Conclusions:Neither IDC nor VV appear to be risk factors for post-operative urinary retention or reoperation after MUS and have little predictive value for outcomes after MUS.

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Effect of Preoperative Voiding Mechanism on Success Rate of Autologous Rectus Fascia Suburethral Sling Procedure

Cited by 8 publications

References 0 publications

Clinical and urodynamic outcomes of pubovaginal sling procedure with autologous rectus fascia for stress urinary incontinence

Clinical and urodynamic outcomes of pubovaginal sling procedure with autologous rectus fascia for stress urinary incontinence

Optimising the tension of an autologous fascia pubovaginal sling to minimize retentive complications

Impaired Detrusor Contractility and the Treatment of Female Stress Urinary Incontinence

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