Skip to main content

Advertisement

SpringerLink
Log in

Transobturator mid-urethral sling in females with stress urinary incontinence and detrusor underactivity: effect on voiding phase

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

To assess whether detrusor underactivity (DU) is a risk factor for voiding dysfunction (VD) after transobturator tape (TOT) and if a detrusor pressure at maximum flow (PdetQmax) value predicts postoperative VD in DU patients. Also, we examined uncomplicated patients for postoperative VD.

Methods

This is a prospective long-term study on SUI patients who underwent TOT. Exclusion criteria were preoperative POP stage ≥ 2, previous anti-incontinence surgery and comorbidities.

Patients were grouped by detrusor contractility using the projected isovolumetric pressure (PIP) index (PdetQmax + maximum flow rate) with values of 30–75 cmH2O indicating normal contractility.

Follow-up was at 1, 3, 6 and 12 months, and then annually. All patients underwent a stress test and responded to the Urogenital Distress Inventory questionnaire and to the King’s Health Questionnaire. The subjective cure was evaluated using the Patient Global Impression of Improvement.

We determined the diagnostic accuracy of PdetQmax levels using ROC curve analysis, with a cut-off point calculated for optimal sensitivity and specificity.

Results

In 2007–2013, 118 patients underwent TOT. We included 50 in the undercontractility group (G1) and 50 in the normocontractility group (G2).

Continence rates were 82% in G1 and 84% in G2 (mean follow-up 76 months). VD increased from 18 to 36% (p < 0.05) in G1 and from 14 to 16% (p = 0.198) in G2. De novo VD was 28% in G1 and 2% in G2.

In the G1 group PdetQmax ≤ 12 cmH2O predicted postoperative VD with 71.4% specificity and 80.0% sensitivity.

Conclusions

DU adversely affects the voiding phase of micturition after TOT. In DU patients, PdetQmax ≤ 12 cmH2O predicts postoperative VD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Schimpf MO, Rahn DD, Wheeler TL, Patel M, White AB, Orejuela FJ, et al. Sling surgery for stress urinary incontinence in women: a systematic review and metanalysis. Am J Obstet Gynecol. 2014;211:71.e1–71.e27.

    Article  Google Scholar 

  2. Karram MM, Segal JL, Vassallo BJ, Kleeman SD. Complications and untoward effects of the tension-free vaginal tape procedure. Obstet Gynecol. 2003;101(5 Pt 1):929–32.

    PubMed  Google Scholar 

  3. Kleeman S, Goldwasser S, Vassallo B, Karram M. Predicting postoperative voiding efficiency after operation for incontinence and prolapse. Am J Obstet Gynecol. 2002;187:49–52.

    Article  PubMed  Google Scholar 

  4. Salin A, Conquy S, Elie C, Touboul C, Parra J, Zerbib M, et al. Identification of risk factors for voiding dysfunction following TVT placement. Eur Urol. 2007;51:782–7.

    Article  PubMed  Google Scholar 

  5. Hong B, Park S, Kim HS, Choo MS. Factors predictive of urinary retention after a tension-free vaginal tape procedure for female stress urinary incontinence. J Urol. 2003;170:852–6.

    Article  PubMed  Google Scholar 

  6. Moore C, Paraiso MF. Voiding dysfunction after the tension-free vaginal tape procedure. Curr Urol Rep. 2005;6:356–9.

    Article  PubMed  Google Scholar 

  7. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Am J Obstet Gynecol. 2002;187(1):116–26.

    Article  PubMed  Google Scholar 

  8. Osman NI, Chapple CR, Abrams P, Dmochowski R, Haab F, Nitti V, et al. Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, etiology, and diagnosis. Eur Urol. 2014;65:389–98.

    Article  PubMed  Google Scholar 

  9. Medina CA, Costantini E, Petri E, Mourad S, Singla A, Rodríguez-Colorado S, et al. Evaluation and surgery for stress urinary incontinence: a FIGO working group report. Neurourol Urodyn. 2017;36:518–28.

    Article  PubMed  Google Scholar 

  10. Griffiths D. Detrusor contractility–order out of chaos. Scand J Urol Nephrol Suppl. 2004;215:93–100.

    Article  Google Scholar 

  11. Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:10–7.

    Article  CAS  PubMed  Google Scholar 

  12. Swift SE, Yoon EA. Test-retest reliability of the cough stress test in the evaluation of urinary incontinence. Obstet Gynecol. 1999;94:99–102.

    CAS  PubMed  Google Scholar 

  13. Artibani W, Pesce F, Prezioso D, Scarpa RM, Zattoni F, Tubaro A, et al. FLOW study group. Italian validation of the urogenital distress inventory and its application in LUTS patients. Eur Urol. 2006;50:1323–9.

    Article  PubMed  Google Scholar 

  14. Ingelmann-Sundberg A, Ulmsten U. Surgical treatment of female urinary stress incontinence. Contrib Gynecol Obstet. 1983;10:51–69.

    Article  Google Scholar 

  15. Kelleher CJ, Cardozo LD, Khullar V, Salvatore S. A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol. 1997;104:1374–9.

    Article  CAS  PubMed  Google Scholar 

  16. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21:5–26.

    Article  PubMed  Google Scholar 

  17. Delorme E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol. 2001;11:1306–13.

    CAS  PubMed  Google Scholar 

  18. Deval B, Jeffry L, Al Najjar F, Soriano D, Darai E. Determinants of patient dissatisfaction after a tension-free vaginal tape procedure for urinary incontinence. J Urol. 2002;67:2093–7.

    Article  Google Scholar 

  19. Bullock TL, Ghoniem G, Klutke CG, Staskin DR. Advances in female stress urinary incontinence: mid-urethral slings. BJU Int. 2006;98(Suppl 1):32–40.

    Article  PubMed  Google Scholar 

  20. Kleeman S, Goldwasser S, Vassallo B, Karram M. Predicting post-operative voiding efficiency after operation for incontinence and prolapse. Am J Obstet Gynecol. 2002;187:49–52.

    Article  PubMed  Google Scholar 

  21. Miller EA, Amundsen CL, Toh KL, Flynn BJ, Webster GD. Preoperative urodynamic evaluation may predict voiding dysfunction in women undergoing pubovaginal sling. J Urol. 2003;169:2234–7.

    Article  PubMed  Google Scholar 

  22. Ahn C, Bae J, Lee KS, Lee HW. Analysis of voiding dysfunction after transobturator tape procedure for stress urinary incontinence. Korean J Urol. 2015;56:823–30.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Cocci A, Cacciamani GE, Russo GI, Cerruto MA, Milanesi M, Medina LG, et al. Impact of preoperative patient characteristics and flow rate on failure, early complications, and voiding dysfunction after a transobturator tape procedure: a multicentre study. Int Neurourol J. 2017;21:282–8.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Linder BJ, Trabuco EC, Gebhart JB, Klingele CJ, Occhino JA, Elliott DS, et al. Can urodynamic parameters predict sling revision for voiding dysfunction in women undergoing synthetic midurethral sling placement? Female Pelvic Med Reconstr Surg. 2017. https://doi.org/10.1097/SPV.0000000000000521.

  25. Resnick NM, Brandeis GH, Baumann MM, DuBeau CE, Yalla SV. Misdiagnosis of urinary incontinence in nursing home women: prevalence and a proposed solution. Neurourol Urodyn. 1996;15:599–613.

    Article  CAS  PubMed  Google Scholar 

  26. Groutz A, Gordon D, Lessing JB, Wolman I, Jaffa A, David MP. Prevalence and characteristics of voiding difficulties in women: are subjective symptoms substantiated by objective urodynamic data? Urology. 1999;54:268–72.

    Article  CAS  PubMed  Google Scholar 

  27. Valentini FA, Robain G, Marti BG. Urodynamics in women from menopause to oldest age: what motive? What diagnosis? Int Braz J Urol. 2011;37:100–7.

    Article  PubMed  Google Scholar 

  28. Griffiths DJ. Editorial: bladder failure—a condition to reckon with. J Urol. 2003;169:1011–2.

    Article  PubMed  Google Scholar 

  29. Griffiths DJ. The mechanics of the urethra and of micturition. Br J Urol. 1973;45:497–507.

    Article  CAS  PubMed  Google Scholar 

  30. Schafer W. Analysis of bladder-outlet function with the linearized passive urethral resistance relation, linPURR, and a disease-specific approach for grading obstruction: from complex to simple. World J Urol. 1995;3:47–58.

    Google Scholar 

  31. Abrams P. Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU Int. 1999;84:14–5.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank David Nicholson for his invaluable help with and revision of the English in this paper.

Author information

Authors and Affiliations

  1. Urogynecology Unit, San Carlo di Nancy Hospital, Via Ottorino Lazzarini, 5, 00136, Rome, Italy

    Franca Natale

  2. Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy

    Ester Illiano & Elisabetta Costantini

  3. Department of Surgical and Biomedical Sciences, Urology and Andrology Clinic, University of Perugia, Perugia, Italy

    Alessandro Zucchi

  4. Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy

    Matteo Balzarro

  5. Section of Gynecology and Obstetrics, Department of Surgery, “Tor Vergata” University, Rome, Italy

    Chiara La Penna

Authors
  1. Franca Natale
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ester Illiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alessandro Zucchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matteo Balzarro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chiara La Penna
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elisabetta Costantini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Franca Natale.

Ethics declarations

Conflicts of interest

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Natale, F., Illiano, E., Zucchi, A. et al. Transobturator mid-urethral sling in females with stress urinary incontinence and detrusor underactivity: effect on voiding phase. Int Urogynecol J 30, 1519–1525 (2019). https://doi.org/10.1007/s00192-019-03871-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-019-03871-7

Keywords

Search

Navigation