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Early voiding dysfunction after midurethral sling surgery: comparison of two management approaches

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Abstract

Introduction and hypothesis

Early voiding dysfunction (EVD) with urinary retention (UR) is a complication of midurethral sling (MUS) surgery. Management is not standardized. Our objective was to characterize management approaches at our center, and report outcomes including resolution of UR, persistent voiding dysfunction, and recurrent stress urinary incontinence (SUI).

Methods

All women requiring catheterization for ≥7 days after MUS surgery during the period March 2014 to 2016 were eligible for inclusion in this prospective study. The management plan for each patient was decided jointly by the surgeon and the patient. Questionnaires regarding urinary symptoms were administered at enrollment, and 3 and 6 months after surgery. The timing and type of any surgical intervention were recorded.

Results

During the 2-year period, 31 women experienced EVD for ≥7 days after MUS surgery. At 6 months, complete data were available for 30 women (97%). Two management approaches were identified: “early mobilization” to loosen the MUS intact (in 10 patients), and continued catheterization with delayed sling lysis as needed (in 21 patients). In eight of the ten women in the early mobilization group, UR resolved after one intervention. Two required a second mobilization. For all women in this group, UR resolved after one or two procedures. In 11 of the 21 women in the continued catheterization group UR resolved without intervention. The other ten women in the continued catheterization group opted for sling lysis ≤6 months after MUS surgery. None of the women in the mobilization group reported SUI at 6 months in contrast to 9 of 20 (45%) in the planned continued catheterization group (p = 0.029). Seven of the nine women experiencing recurrent SUI had undergone sling lysis.

Conclusions

Patients experiencing EVD after MUS surgery can be informed that UR will resolve in 50% with continued catheterization. Mobilization should be an option for those not comfortable with prolonged catheterization. Early intervention by mobilization may be associated with a lower risk of recurrent SUI, compared to continued catheterization and delayed sling lysis.

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Acknowledgements

The authors gratefully acknowledge funding from the Leadership Circle, Department of Obstetrics & Gynecology, University of Calgary, for this project. We thank Brittany Hoffarth-Palchewich for identifying cases of EVD, and aiding in study recruitment.

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Authors and Affiliations

  1. Division of Urogynecology, Department of Obstetrics & Gynecology, University of Calgary, 4th floor, North Tower, Foothills Hospital, 1403-29 Street NW, Calgary, AB, Canada, T2N 2T9

    Erin A. Brennand, Colin Birch, Magali Robert & Shunaha Kim-Fine

  2. Department of Obstetrics & Gynecology, University of Calgary, 4th floor, North Tower, Foothills Hospital, 1403-29 Street NW, Calgary, AB, Canada, T2N 2T9

    Selphee Tang

Authors
  1. Erin A. Brennand
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  2. Selphee Tang
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  3. Colin Birch
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  4. Magali Robert
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  5. Shunaha Kim-Fine
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Corresponding author

Correspondence to Erin A. Brennand.

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Conflicts of interest

Erin Brennand and Magali Robert have received grant-in-aid research funding from Boston Scientific. Selphee Tang, Colin Birch and Shunaha Kim-Fine report no conflicts of interest.

Financial support

This study was supported by a Leadership Circle grant from the Department of Obstetrics & Gynecology, University of Calgary.

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Brennand, E.A., Tang, S., Birch, C. et al. Early voiding dysfunction after midurethral sling surgery: comparison of two management approaches. Int Urogynecol J 28, 1515–1526 (2017). https://doi.org/10.1007/s00192-017-3302-y

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  • DOI: https://doi.org/10.1007/s00192-017-3302-y

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