Narrow Vagina as a Predictor of Obstructive Voiding Dysfunction after Transobturator Sling Surgery

Urol Int. 2021;105(11-12):1092-1098. doi: 10.1159/000517544. Epub 2021 Aug 26.

Abstract

Background: Voiding dysfunction (VD) is a potential complication after female midurethral sling operations.

Objectives: Our goal was to assess the rate of obstructive VD after -transobturator tension-free tape (TOT) procedures and to find perioperative risk factors (RFs) predicting postoperative voiding problems.

Methods: We have retrospectively evaluated the perioperative data of 397 women who underwent TOT operations. Significant post-void residual (PVR) (>50 mL) was considered as the primary (objective) end point of the study, the voiding difficulty as the secondary (subjective) 1. First univariate analysis and then multivariate logistic regression were performed, with a 5% significance level.

Results: Significant PVR was present in 51 (12.8%) women; catheterization was needed in 21 (5.3%) and reoperation in 3 (0.8%) cases. Seventy women (17.6%) experienced postoperative voiding difficulty. Narrow vagina (<2 cm), older age >70 years, and preoperative voiding difficulty were independent RFs for significant PVR (odds ratio: 5.07, 2.14, 5.38, respectively, p < 0.05). Preoperative overactive bladder syndrome and previous pelvic organ prolapse surgery were considered independent RFs for postoperative voiding difficulty.

Conclusions: Older age, narrow vagina, or preoperative voiding difficulty increases the chance for significant postoperative PVR. These patients should be chosen and counseled appropriately.

Keywords: Counseling; Female stress urinary incontinence; Narrow vagina; Transobturator midurethral sling; Voiding dysfunction.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Middle Aged
  • Predictive Value of Tests
  • Reoperation
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Suburethral Slings*
  • Treatment Outcome
  • Urinary Incontinence, Stress / pathology
  • Urinary Incontinence, Stress / physiopathology
  • Urinary Incontinence, Stress / surgery*
  • Urinary Retention / etiology*
  • Urinary Retention / pathology
  • Urinary Retention / physiopathology
  • Urinary Retention / surgery
  • Urologic Surgical Procedures / adverse effects
  • Urologic Surgical Procedures / instrumentation*
  • Vagina / pathology*