Assessment of urinary dysfunction following midurethral sling placement: a comparison of two voiding trial methods.

STUDY OBJECTIVE: Temporary urinary retention after midurethral sling (MUS) surgery requiring indwelling catheter or self-catheterization usage is common. Different methods for assessment of immediate postoperative urinary retention have been described. The aim of this study was to compare postoperative voiding trial (VT) success following active versus passive voiding trial in women undergoing MUS surgery.

DESIGN: Comparative retrospective cohort study.

SETTING: Female pelvic medicine and reconstructive surgery practice at a university affiliated tertiary medical center.

PATIENTS: Patients with stress urinary incontinence who underwent surgical treatment during the study period were eligible for inclusion. Excluded were patients under the age of 18, combined cases with other surgical services, planned laparotomy, patients with history of urinary retention and patients for whom their VT was performed on postoperative day 1. The cohort was divided into two groups: 1) patients who underwent an active retrofill of their bladder using a Foley catheter; 2) patients who were allowed to have a spontaneous void.

INTERVENTIONS: none.

MEASUREMENTS AND MAIN RESULTS: Two hundred and eighty-five patients met the inclusion criteria for the study. Of these subjects, 94 underwent an active voiding trial and 191 underwent a passive voiding trial. There were no statistically significant differences in immediate postoperative urinary retention (30.8% vs. 29.3%, p=0.79) or time from surgery end to voiding trial (233.0 ± 167.6 minutes vs. 203.1 ± 147.8 minutes, p=0.13) between groups. Urinary retention, as defined by a failed voiding trial, increased from 10% to 29.3% when MUS placement was accompanied by concomitant prolapse repair procedure. Multivariate logistic regression analysis revealed that undergoing a combined anterior and posterior colporrhaphy (OR 5.13, p <0.001) as well as undergoing an apical prolapse procedure (OR 2.75, p=0.004) were independently associated with immediate postoperative urinary retention while increased BMI (OR 0.89, p<0.001) lowered likelihood of retention.

CONCLUSION: The method used to assess immediate postoperative urinary retention did not affect VT success. Concomitant combined anterior and posterior colporrhaphy and apical suspension were correlated with greater likelihood of VT failure while increased BMI decreased odds of retention.