AUA 2018: Concomitant Procedures Performed at the Time of Midurethral Sling Affect Post Operative Urinary Retention Rate

San Francisco, CA USA (UroToday.com) Urinary retention is a well-known risk factor in the surgical treatment of stress urinary incontinence (SUI) with midurethral sling (MUS). Urinary retention is usually transient, however close to 2% of women will undergo a sling revision or removal surgery for urinary retention. Regardless of its transient nature, the time spent with an indwelling catheter or performing self-catheterization is frustrating for patients. Appropriate and thorough counseling pre-operatively can minimize this frustration. In order to do this effectively, clinicians will need to be able to identify risk factors that make urinary retention more likely. The authors here aim to identify risk factors for urinary retention as related to concomitant procedures performed at the time of MUS.

A retrospective review was performed of all patients who underwent MUS at the authors’ institution from 1/2014 to 8/2017. In addition to concomitant procedures, the authors looked at age, BMI, operative time, and length of hospital stay. Urinary retention was defined as having failed at least one voiding trial post operatively. Surgical factors examined included anterior repair only, posterior repair only, combined anterior and posterior repair, robotic sacrocolpopexy, open surgery, and vaginal surgery.

A total of 453 MUS were performed during the study period, of which 209 patients had complete data and were analyzed. The overall rate of urinary retention was 24%. Age, BMI, operative time, and length of hospital stay did not differ between patients with and without urinary retention. The odds ratio for urinary retention in patients who underwent 2 or more procedures in addition to MUS was 2.72. Anterior repair, posterior repair, and robotic sacrocolpopexy alone were not significantly associated with an increased likelihood for urinary retention. The same was true for concomitant procedures performed vaginally or open. There was no association between urinary retention and bladder perforation, urinary tract infection, and future sling revision.

This was an interesting study that evaluated surgical factors contributing to urinary retention after MUS. It is noteworthy that the urinary retention rate was high, at 24%, but the vast majority of these patients had only transient retention. The authors concluded that it is not the type, but rather the number, of concomitant procedures performed at the time of MUS that will influence the risk of urinary retention. Patients who have 2 or more procedures performed at the time of MUS are nearly three times more likely to experience postoperative urinary retention.

Presented by: Paige Kuhlmann, MD; Cedars Sinai Medical Center

Written by: Dena Moskowitz, MD; Fellow, Female Pelvic Medicine and Reconstructive Surgery, Virginia Mason Medical Center, Twitter: @demoskowitz, at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA

Reference
Jonsson Funk M, Siddiqui NY, Pate V, Amundsen CL, Wu JM. Sling revision/removal for mesh erosion and urinary retention: long-term risk and predictors. Am J Obstet Gynecol. 2013;208(1):73.e1-e73.e7. doi:10.1016/j.ajog.2012.10.006
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