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Abstract
Purpose
To compare the incidence of postoperative de novo voiding dysfunction and to identify the risk factors affecting the development of de novo voiding dysfunction after various midurethral sling (MUS) procedures for female stress urinary incontinence (SUI).
Materials and Methods
Women with SUI underwent MUS by various procedures [tension-free vaginal tape (TVTⓇ), tension-free vaginal tape obturator (TVTOⓇ), tension-free obturator tape (TOTⓇ), or TVT-secureⓇ]. Cases were reviewed retrospectively with followup of at least 6 months. The subjects were divided into 2 groups according to the presence of postoperative de novo voiding dysfunction. De novo voiding dysfunction was defined as a low maximal uroflow rate (Qmax<15 ml/s) or a large postvoided residual urine volume (PVR >100 ml) observed at 6 months postoperatively. Clinical and urodynamic parameters were compared between the voiding dysfunction (Group I) and normal voiding (Group II) groups according to MUS procedure.
Results
Of the 625 subjects, 163 (26%) patients showed evidence of de novo voiding dysfunction (Group I). Of these 163 subjects, 12 (7.3%) patients complained of voiding symptoms. There was no difference in the incidence of de novo voiding dysfunction according to MUS procedure. Multivariate analysis showed Qmax to be the only independent risk factor for de novo voiding dysfunction.
Conclusions
This study confirmed the considerable incidence of postoperative de novo voiding dysfunction, which is, however, mostly asymptomatic. As preoperative Qmax decreased, the chance of postoperative de novo voiding dysfunction increased. Identification of risk factors of voiding dysfunction in women undergoing MUS may help in planning for better followup and early detection of possibly inherent late complications of voiding dysfunction.
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Table 1.
Comparisons of demographic data between the postoperative voiding dysfunction group (Group 1) and the normal voiding group (Group 2)
| Total patients | Group 1 | Group 2 | p-value | |
|---|---|---|---|---|
| No. of patients | 625 | 163 | 462 | |
| Age (years) | 51.6±9.4 | 51.2±9.3 | 53.1±9.9 | 0.124a |
| Body mass index | 25.1±3.2 | 25.1±3.2 | 25.2±3.4 | 0.810a |
| Diabetes mellitus (+) | 34 (5.4%) | 8 (7.5%) | 26 (5.0%) | 0.829b |
| Parity (number of birth) | 2.5±1.6 | 2.5±1.1 | 2.6±1.2 | 0.639b |
| Stamey sx grade (I/II/III) | 204/405/16 | 38/64/5 | 166/341/11 | 0.843b |
| Cystocele (I/II/III/IV) | 207/79/19/5 | 36/22/5/2 | 171/57/14/3 | 0.721b |
| Rectocele | 37 | 9 | 28 | 0.562b |
| Surgical methods | ||||
| TVT | 245 | 52 | 193 | |
| TVTO | 128 | 32 | 96 | 0.294 |
| TOT | 115 | 21 | 94 | 0.294 |
| TVT-secure | 131 | 23 | 108 | |
| Preoperative | ||||
| Qmax (ml/sec) | 21.3±11.7 | 25.2±10.2 | <0.001a | |
| Voided volme (ml) | 249.0±129.2 | 268.5±132.9 | 0.172a | |
| Postvoid, residual (ml) | 30.3±34.9 | 20.7±43.7 | 0.922a | |
| Pdetmax (mmHg) | 21.7±14.4 | 20.5±12.2 | 0.416a | |
| Delta Qmax (ml/sec) | −11.79±6.65 | −4.9±6.55 | <0.001a,c |
Table 2.
Analysis of risk factors for postoperative voiding dysfunctionafter midurethral sling
| OR | 95% CI | p-valuea | |
|---|---|---|---|
| Age | 1.012 | 50.90-52.37 | 0.518 |
| Height | 1.107 | 15.21-16.06 | 0.582 |
| Weight | 0.901 | 60.90-62.11 | 0.700 |
| Body mass index | 0.803 | 24.89-25.40 | 0.754 |
| Parity | 0.987 | 2.33-2.50 | 0.831 |
| Diabetes mellitus | 0.908 | 0.601 | |
| Symptom duration | 0.998 | 49.57-59.26 | 0.321 |
| Cystocele | |||
| 1 | 0.776 | 0.814 | |
| 2 | 1.454 | 1.459 | |
| 3 | 0.862 | 0.834 | |
| 4 | 1.103 | 0.993 | |
| Symptom grade | |||
| 1 | |||
| 2 | 0.091 | 0.688 | |
| 3 | 0.546 | 0.650 | |
| Preoperative | |||
| Qmax (ml/sec) | 0.95 | 23.73-25.0 | <0.001 |
| Postvoid, residual (ml) | 1.00 | 17.48-24.11 | 1.000 |
| Pdetmax (mmHg) | 0.985 | 21.45-22.72 | 0.985 |
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