SUFU 2018: Urinary Retention After Advance® Sling: A Multi-Institutional Retrospective Study
Retrospective study using medical records of patients who underwent AdVance® sling insertion across four institutions over a ten-year period from 2007-2017 were reviewed. 255 patients who had at least one post-operative visit were included in the study. Post-operative urinary retention was defined as either a complete inability to urinate or an elevated post-void residual (PVR) of greater than 350cc.
The authors reported 255 patients included in the study 27 patients (10.6%) had urinary retention at the time of their first post-operative visit, and an additional 3 patients had new urinary retention at the time of their second post-operative visit for an overall initial postoperative urinary retention rate of 11.8% (30/255). These patients either underwent placement of Foley catheter (18/27, 66.7%) or were initiated on clean intermittent catheterization (CIC) (9/27, 33.3%). The majority (16/27, 59.2%) of patients experienced resolution of retention by their second post-operative visit. No patients required surgical intervention such as placement of suprapubic tube, sling manipulation or incision. At last follow-up, only 16.7% (5/30) of the patients who experienced post-operative urinary retention had persistent urinary retention at a mean follow-up of 430 days (Range 5 to 2,235) for an overall long term retention rate of 1.96% (5/255). 2 of these patients had known pre-existing neurogenic bladder. Patients who experienced post-operative retention were significantly more likely to have a pre-operative PVR ≥ 165 mL (5/19, 26.3%) compared to those who did not have urinary retention (10/169, 5.9%) (p= 0.0018). Additionally, patients that experienced urinary retention were more likely to experience other complications (p=0.0014). Post-operative UTI had a significant association with urinary retention after AdVance sling (p=0.0022).
The authors concluded that urinary retention after AdVance sling placement is an uncommon event, is generally self-limited and can safely be managed with either foley catheter or CIC. In addition, patients with urinary retention are more likely to have an elevated pre-operative PVR and to experience other complications post-operatively.
Presented by: Jennifer Rolef MD, Medical University of South Carolina, Charleston, SC
Co Authors: Goran Rac MD¹, Lauren Rittenberg MD¹, Lindsey Cox MD¹, Arthur Mourtzinos MD², Leaney Westney MD³, Mike Metro MD⁴ and Eric Rovner MD¹
Author Information:
1. Medical University of South Carolina, Charleston, SC
2. Lahey Clinic, Burlington, MA
3. MD Anderson, Houston, TX
4. Temple University, Philadelphia, PA
Written by: Bilal Farhan, MD, Female Urology Fellow and Voiding Dysfunction, Department of Urology, University of California, Irvine at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting (SUFU 2018), February 27-March 3, 2018, Austin, Texas