MP38-18 EFFECT OF PREOPERATIVE VOIDING DYSFUNCTION ON VOIDING TRIAL AFTER MIDURETHRAL SLING PROCEDURE IN WOMEN WITH STRESS URINARY INCONTINENCE (2014)

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence Therapy II1 Apr 2014MP38-18 EFFECT OF PREOPERATIVE VOIDING DYSFUNCTION ON VOIDING TRIAL AFTER MIDURETHRAL SLING PROCEDURE IN WOMEN WITH STRESS URINARY INCONTINENCE Ji Yun Chae, Sang Woo Kim, Jong Jin Park, Jong Wook Kim, Jin Wook Kim, Sung Gu Kang, Mi Mi Oh, Cheol Yong Yoon, Jae Hyun Bae, Seok Ho Kang, Hong Seok Park, Jun Cheon, Jeong Gu Lee, Je Jong Kim, and Du Geon Moon Ji Yun ChaeJi Yun Chae More articles by this author , Sang Woo KimSang Woo Kim More articles by this author , Jong Jin ParkJong Jin Park More articles by this author , Jong Wook KimJong Wook Kim More articles by this author , Jin Wook KimJin Wook Kim More articles by this author , Sung Gu KangSung Gu Kang More articles by this author , Mi Mi OhMi Mi Oh More articles by this author , Cheol Yong YoonCheol Yong Yoon More articles by this author , Jae Hyun BaeJae Hyun Bae More articles by this author , Seok Ho KangSeok Ho Kang More articles by this author , Hong Seok ParkHong Seok Park More articles by this author , Jun CheonJun Cheon More articles by this author , Jeong Gu LeeJeong Gu Lee More articles by this author , Je Jong KimJe Jong Kim More articles by this author , and Du Geon MoonDu Geon Moon More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1275AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Rarely has voiding dysfunction (VD) been closely examined with regard to voiding pattern after sling procedure. The aim of this study was to elucidate whether VD may have an impact on voiding trial after midurethral sling (MUS) procedure in women with stress urinary incontinence (SUI). METHODS 168 women with SUI who had undergone a MUS procedure between June 2010 and June 2012 were retrospectively analyzed. The subjects were divided into 2 groups according to the presence of VD by preoperative uroflowmetry. We defined VD to including at least one of maximal flow rate under 15ml/sec, or postvoid residual urine volume (PVR) more than 50ml. Uroflowmetry was followed up postoperatively. Failure of voiding trial was defined as PVR more than 100ml at voiding trial. Surgical results, postoperative uroflowmetry parameters were compared. RESULTS Preoperatively, 48 patients had VD. Although VD group showed significantly lower maximal flow rate in all of postoperative uroflowmetry at discharge day, postoperative 14th day, 3rd, 12th month, there were no significant differences in the rate of failure of voiding trial or in the rate of performing CIC after MUS procedure between the two groups. In VD group, 31 patients had bladder outlet obstruction (BOO) and 17 had detrusor underactivity (DU). There were no significant differences in the rates of voiding trial failure, performing clean intermittent catheterization, or surgical success after MUS procedure between BOO and DU group. CONCLUSIONS Obstructive effects on voiding after urethral sling procedure have been reported, and the effect may become prominent in women with VD. This study showed that those with preoperative VD, either with BOO or DU, experienced no definite unfavorable therapeutic outcome of MUS procedure compared to those with normal voiding function. MUS may be regarded as safe, successful procedure not only in women with SUI and normal voiding function, but also in those with SUI and VD. Table 1. Comparison of voiding parameters of women with SUI according to the presence or absence of voiding dysfunction by preoperative uroflowmetry. Parameter Voiding dysfunction Present (n=48) Voiding dysfunction Absent (n=120) p-value Age (yr) 59.3±9.9 57.2±34.7 0.689 Preoperative Uroflowmetry Qmax (ml/s) 12.2±4.9 26.3±8.1 ≤ 0.001 Voided volume (ml) 183.2±73.8 237.2±113.5 0.003 PVR (ml) 24.7±45.5 14.1±12.1 0.121 Preoperative Urodynamic parameters Pdetmax in filling cystometry (cmH2O) 9.6±2.0 9.5±3.1 0.865 Maximal bladder capacity (ml) 298.9±68.0 293.0±86.5 0.670 Compliance 29.9±6.8 29.3±8.6 0.666 PdetQmax (cmH2O) 18.0±9.0 20.0±15.4 0.394 Pdetmax (cmH2O) 28.3±18.0 32.1±20.1 0.257 VLPP (cmH2O) 58.3±25.5 51.7±26.5 0.154 Postoperative voiding trial at discharge day CIC (%) 13 (27.1%) 20 (16.7%) 0.125 Failure of voiding trial (%) 15 (31.2%) 27 (22.5%) 0.254 Qmax (ml/s) 17.1±9.3 24.4±11.7 ≤ 0.001 PVR (ml) 95.4±111.6 76.1±88.9 0.252 Voiding trial at postoperative 14th day Failure of voiding trial (%) 2 (4.1%) 2 (1.6%) 0.337 Qmax (ml/s) 16.9±9.4 22.3±9.9 0.001 PVR (ml) 20.3±25.5 21.5±22.4 0.767 Voiding trial at postoperative 3rd month Failure of voiding trial (%) 1 (2.1%) 0 (0%) 0.100 Qmax (ml/s) 13.7±6.6 22.1±9.2 ≤ 0.001 PVR (ml) 17.3±28.5 20.3±16.4 0.482 Voiding trial at postoperative 12th month Failure of voiding trial (%) 1 (2.1%) 0 (0%) 0.106 Qmax (ml/s) 12.4±7.7 21.2±7.8 ≤ 0.001 PVR (ml) 17.2±27.0 19.3±20.3 0.789 Continence (%) 47 (97.9%) 115 (95.8%) 0.500 Qmax: maximal urine flow rate; PVR: postvoid residual urine volume; Pdetmax: maximal detrusor pressure; PdetQmax: detrusor pressure at maximal urine flow rate; VLPP: valsalva leak point pressure; CIC: clean intermittent catheterization Table 2. Comparison of voiding parameters of women with SUI according to the presence of bladder outlet obstruction or detrusor underactivity by preoperative urodynamic study. Parameter Bladder outlet obstruction (n=31) Detrusor underactivity (n=17) p-value Preoperative Uroflowmetry Qmax (ml/s) 12.5±5.7 11.6±2.9 0.550 Voided volume (ml) 201.8±89.7 149.2±60.3 0.036 PVR (ml) 22.7±36.6 28.2±59.6 0.694 Preoperative Urodynamic parameters Pdetmax in filling cystometry (cmH2O) 10.0±1.0 8.8±3.3 0.163 Maximal bladder capacity (ml) 308.0±22.7 282.3±110.3 0.356 Compliance 30.8±2.2 28.2±11.0 0.356 PdetQmax (cmH2O) 22.5±7.2 9.7±5.3 ≤ 0.001 Pdetmax (cmH2O) 36.7±16.7 13.1±6.8 ≤ 0.001 VLPP (cmH2O) 59.6±25.9 56.1±25.4 0.652 Postoperative voiding trial at discharge day CIC (%) 10 (32.2%) 3 (17.6%) 0.276 Failure of voiding trial (%) 11 (35.4%) 4 (23.5%) 0.353 Qmax (ml/s) 16.3±9.3 18.3±9.5 0.510 PVR (ml) 93.2±104.7 99.3±126.6 0.864 Voiding trial at postoperative 14th day Failure of voiding trial (%) 1 (3.2%) 1 (5.8%) 0.660 Qmax (ml/s) 15.9±7.6 18.5±12.0 0.425 PVR (ml) 21.0±26.2 19.1±24.9 0.807 Voiding trial at postoperative 3rd month Failure of voiding trial (%) 0 (0%) 1 (5.8%) 0.170 Qmax (ml/s) 14.3±7.0 12.6±6.2 0.514 PVR (ml) 11.7±6.9 27.4±46.7 0.292 Voiding trial at postoperative 12th month Failure of voiding trial (%) 2 (6.4%) 2 (11.7%) 0.480 Qmax (ml/s) 11.5±2.3 12.2±7.7 0.383 PVR (ml) 10.0±10.0 26.5±32.9 0.261 Continence (%) 31 (100%) 16 (94.1%) 0.172 Qmax: maximal urine flow rate; PVR: postvoid residual urine volume; Pdetmax: maximal detrusor pressure; PdetQmax: detrusor pressure at maximal urine flow rate; VLPP: valsalva leak point pressure; CIC: clean intermittent catheterization © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e409-e410 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Ji Yun Chae More articles by this author Sang Woo Kim More articles by this author Jong Jin Park More articles by this author Jong Wook Kim More articles by this author Jin Wook Kim More articles by this author Sung Gu Kang More articles by this author Mi Mi Oh More articles by this author Cheol Yong Yoon More articles by this author Jae Hyun Bae More articles by this author Seok Ho Kang More articles by this author Hong Seok Park More articles by this author Jun Cheon More articles by this author Jeong Gu Lee More articles by this author Je Jong Kim More articles by this author Du Geon Moon More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...