Comparing postoperative voiding dysfunction after mid-urethral sling using either a Babcock or Kelly clamp tensioning technique
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Introduction and hypothesis
The objective was to compare postoperative urinary retention using the Babcock and Kelly clamps for retropubic midurethral sling (RPS) tensioning.
This was a retrospective cohort of isolated RPS procedures from December 2010 through April 2016 by five fellowship-trained surgeons at two institutions. Slings were tensioned with a Babcock clamp by grasping a 3-mm midline fold of mesh (RPS-B) or a Kelly clamp as a spacer between the sling and suburethral tissue (RPS-K). Assessment of urinary retention included the primary outcome of postoperative catheterization and several secondary outcomes, including discharge home with a catheter, within 1 year of surgery. Analysis of covariance was used to compute the mean difference in duration of catheterization and log-binomial regression was used to calculate risk ratios (RR) and 95% confidence intervals (CI).
We included 240 patients. The RPS-B group had a lower body mass index and was more likely to be menopausal, have had pelvic organ prolapse surgery, and have a lower maximum urethral closure pressure than the RPS-K group. The mean duration of catheterization was similar, as demonstrated by the crude (0.21 days [−0.30–0.71]) and BMI-adjusted (0.07 days [−0.41–0.55]) mean difference in duration of catheterization. The incidence of postoperative OAB symptoms was comparable between the groups (BMI-adjusted RR: 0.95 (0.80–1.1)), and the incidence of revision did not differ (p = 0.7).
The Babcock and Kelly clamp tensioning techniques appear comparable, with a low incidence of prolonged postoperative catheterization. Most catheters were removed on the day of the surgery. It is reasonable to tension retropubic midurethral slings with either method.
KeywordsRetropubic midurethral sling Sling tensioning Urinary retention Sling revision
This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102), and financial contributions from Harvard University and its affiliated academic healthcare centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University, and its affiliated academic healthcare centers, or the National Institutes of Health.
Compliance with ethical standards
Conflicts of interest
PR is a consultant and has received research support from Boston Scientific and Coloplast. For the remaining authors no conflicts of interest were declared.
- 1.ACOG, AUGS. Practice Bulletin 155—Urinary Incontinence in Women. https://www.acog.org/-/media/Practice-Bulletins/Committee-on-Practice-Bulletins----Gynecology/pb155.pdf?dmc=1&ts=20161127T1754149626. Accessed 27 November 2016.
- 2.Hannestad YS, Rortveit G, Sandvik H, Hunskaar S. Norwegian EPINCONT study. Epidemiology of incontinence in the county of Nord-Trøndelag. A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of incontinence in the county of Nord-Trøndelag. J Clin Epidemiol. 2000;53(11):1150–7.CrossRefGoogle Scholar
- 10.Walters MD, Karram M. Chapter 20: Synthetic midurethral slings for stress urinary incontinence. In: Urogynecology and Reconstructive Pelvic Surgery. p. 272–294. https://www-clinicalkey-com.ezp-prod1.hul.harvard.edu/#!/content/book/3-s2.0-B9780323113779000207?scrollTo=%23s0020. Accessed 30 November 2016.
- 15.Boston Scientific. Advantage Fit, transvaginal mid-urethral sling system. 2013. http://www.bostonscientific.com/content/dam/bostonscientific/uro-wh/portfolio-group/sling-systems/advantage-fit/Advantage-Fit-Brochure.pdf. Accessed 29 November 2016.
- 16.Ethicon. Gynecare TVT Exact. 2009. http://hostedvl106.quosavl.com/cgi-isapi/server.dll?8080?IFUs?.cmt1bWFyMTJAaXRzLmpuai5jb20=?GetOneDocPureFullTxt?oipbo5hf99cktfm4d700s6292o?8. Accessed 29 November 2016.
- 17.Ethicon. Gynecare TVT—tension-free vaginal tape. 2015. http://hostedvl106.quosavl.com/qb/doc/0nnlfm86hbpkf33bt7pl38flvg.