The optimal method of managing stress urinary incontinence (SUI) in women undergoing colpocleisis remains unclear, especially in a setting of urinary retention. We aim to compare postoperative retention after colpocleisis with or without concomitant midurethral sling (MUS).
A retrospective chart review of all women who underwent colpocleisis with or without MUS from October 2007 to October 2017 was performed. Women with preoperative and 2-week postoperative post-void residual volume (PVR) measurements were included. Urinary retention was defined as PVR of ≥100 ml. Analysis included t tests/Wilcoxon rank, Chi-squared/Fisher's exact, and multivariate linear regression models.
A total of 231 women with a mean age of 77.7 years (± 6.0 years SD) met the inclusion criteria. One hundred and thirty-eight women underwent colpocleisis alone, whereas 93 women had colpocleisis with MUS. Preoperative retention rates were high (44.9% vs 34.4%, for colpocleisis alone versus with MUS, p = 0.114). Postoperative retention rates were lower and similar between the groups (10.1% vs 11.8%, for colpocleisis alone vs with MUS, p = 0.69). Linear regression models showed the adjusted odds ratio for postoperative urinary retention in patients with concomitant MUS was 1.68 (95% confidence interval: 0.64-4.41) compared with patients with colpocleisis alone and this did not reach statistical significance (p = 0.292). Fortunately, after colpocleisis, women had high rates of resolution of retention, regardless of MUS (80.3% vs 90.6% for colpocleisis alone vs with MUS; p = 0.20). Few women required reoperation for retention (3.1%).
Placement of an MUS at the time of colpocleisis is a safe and effective therapy. This appears to be unaffected by preoperative urinary retention status.
International urogynecology journal. 2021 Feb 06 [Epub ahead of print]
Birte J Wolff, Spencer Hart, Cara J Joyce, Rhea B Eubanks, Elizabeth R Mueller, Thythy T Pham
Department of Obstetrics/Gynecology and Urology, Loyola University Chicago Stritch School of Medicine and Loyola University Medical Center, 2160 S First Avenue, Maywood, IL, 60153, USA. ., Department of Obstetrics/Gynecology and Urology, Loyola University Chicago Stritch School of Medicine and Loyola University Medical Center, 2160 S First Avenue, Maywood, IL, 60153, USA., Biostatistics Core, Public Health Sciences, Center for Translational Research and Education, Loyola University Chicago, Maywood, USA., Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.