VOIDING DYSFUNCTIONS AFTERMIDURETRHAL SLING PLACEMENT IN A LARGE DATASET COHORT
T. RABY1, P. A. ROJAS2, M. ARELLANO 3, M. ALVAREZ 4, C.GONZÁLEZ 4, B. BLUMEL 3, D. S. POLHAMMER 1,R. CUEVAS 5, H. B. GOLDMAN 6, S. VIGUERA 7,J. PIZARRO-BERDICHEVSKY 1;
1UrogynecologyUnit; División Obstetricia y Ginecología, Dr. Sótero del RioHosp.-Pontificia Univ. Católica de Chile, Santiago, Chile, 2UrologyUnit, Pontificia Univ. Católica de Chile, Santiago, Chile,3Urogynecology Unit, Dr. Sótero del Rio Hosp.-ClínicaSanta María, santiago, Chile, 4Pontificia Univ. Católicade Chile, Santiago, Chile, 5Urogynecology Unit, Obstetricsand Gynecology Divi, H. Dr. Sotero del Rio; Pontificia Univ. Cat,Santiago, Chile, 6cleveland clinic, cleveland, OH,7Pontificia Univ. Católica de Chile, SANTIAGO, Chile.
Introduction: Midurethral slings(MUS) are the current standard surgery for stress urinaryincontinence (SUI). Among complications, post MUS voiding dysfunction(VD) can significantly affect patient QoL.
Objective: Ourprimary aim was described the rate of VD in a large dataset of MUSpatients.
Methods: A retrospective analysis of ourprospectively collected database was performed. Inclusion criterion:patients who underwent MUS (TVT or TOT) between 2008 and 2016 with atleast 1 follow-up (F/U) visit. Procedures were carried out by 5trained-urogynecologists. ICS/IUGA VD definition included thepresence of any of the following: hesitancy, slow stream,intermittency, straining to void, spraying of urinary stream, feelingof incomplete bladder emptying, need to immediately re-void,postmicturition leakage or position-dependent micturition. Rates ofrecurrent SUI (subjective complaint of SUI or leakage during exam),mesh extrusion and de novo urgency were also evaluated. Data is shownas percentage or median (IQR).
Results: 875 patientsunderwent MUS in the study period, 82 did not had f/u and wereexcluded, therefore we analyzed 793 patients. Of these, 44.9% (393)were TOT and 55.1% (482) TVT. 70% (612) were hand-made slings and 30%(263) were commercial kits. Median age was 54 (±10.1) years. 24%(212) had a concomitant apical prolapse repair and 26.1% had aconcomitant anterior and 18.4% had posterior colporrhaphy. In the TVTgroup there was a 2.1% risk of bladder perforation. 82 (9.4%)patients developed VD in a median time of 8 months (2-20) aftersurgery, of whom 10 patients (12% of the VD patients) underwent amesh removal. VD was present in 9.2% of TOT and 9.5% of TVT. The mostfrequent VD symptom were slow stream (5%), feeling of incompletebladder emptying (4%) and need to immediately re-void (3.7%). Inother outcomes, 9.3% had recurrent objective or subjective orreintervention for SUI. 2.1% developed a mesh extrusion and 6.5%developed de novo urgency during f/u. In a univariable analysis thefollowing were associated with VD: type of incontinence, concomitantcolporraphy, POP -Q stage III or IV, active smokers. In a Coxproportional analysis including theses variables, age, concomitantapical repair, the following variables persist significant associatedwith VD: concomitant colporraphy OR 0.47(CI 95% 0.26-0.85), POP -Qstage III or IV OR 2.6 (CI 95% 1.3-5.1)and active smokers OR 0.5 (CI95% 0.3-0.9).
Conclusions: In our cohort VD are a commoncomplication affecting 9.2% of patients. Concomitant anterior orposterior colporraphy and the use of tobacco were protective factorsfor VD. The only risk factor was severe prolapse (Stage III or IV)increasing the risk by 2.6 fold. In our cohort 90.8% of MUS patientshad SUI resolution and a low rate of complications.