MP33-18 A COMPARISON OF OUTCOMES AFTER RETROPUBIC MID-URETHRAL SLING, DOES VALSALVA VOIDING AFFECT SUCCESS RATE?

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence Therapy I1 Apr 2014MP33-18 A COMPARISON OF OUTCOMES AFTER RETROPUBIC MID-URETHRAL SLING, DOES VALSALVA VOIDING AFFECT SUCCESS RATE? Blake Anderson, David Hatcher, Rena Malik, Jessica Volsky, Gregory Bales, and Doreen Chung Blake AndersonBlake Anderson More articles by this author , David HatcherDavid Hatcher More articles by this author , Rena MalikRena Malik More articles by this author , Jessica VolskyJessica Volsky More articles by this author , Gregory BalesGregory Bales More articles by this author , and Doreen ChungDoreen Chung More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.969AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It is known that many women void via valsalva and that retropubic slings (RPS) may cause voiding dysfunction. The aim of this study was to compare outcomes after RPS in women with and without valsalva voiding. METHODS 95 women had RPS placed for stress urinary incontinence (SUI) from 2011 to 2013. Baseline demographics, urodynamic findings, operative parameters, and post-operative course were examined retrospectively. Valsalva voiding was defined as abdominal straining witnessed while voiding during urodynamics. Standardized follow-up was at 1, 3, 6, and 12 months. The primary outcome was subjective success rate (absence of SUI with physical activity, coughing, or sneezing). We also looked at Urogenital Distress Inventory (UDI-6) score, Incontinence Impact Questionnaire (IIQ-7) score, post-void residual (PVR), pad use, complications, and revision rate. Tests of significance were done using Fisher’s exact tests and Student’s t-tests. RESULTS Subjects included 45 (47%) valsalva voiders (VV) and 50 (53%) non-valsalva voiders (NV). No differences were seen between groups in mean age, PVR, or capacity. Abdominal leak point pressure without a catheter was significantly lower in VV (56 vs. 70 cm H2O, p=0.045), yet VV had less severe IIQ-7 at baseline compared to NV, (9 ± 6 vs. 13±7, p=0.01). Catheter time was significantly shorter in VV compared to NV (2.5 vs. 4.1 days, p=0.03). No differences were seen between groups in the rate of passing initial void trial (71% VV vs. 61% NV, p=0.1). In the perioperative period, 4.7% of VV and 11.9% of NV required clean intermittent catheterization (CIC) (p=0.16). No patients required CIC beyond 4 weeks. Complication rates (11.4% VV vs. 9.3% NV, p=0.3) and revision rates (7.1% VV vs. 9.5% NV, p=0.28) were similar. In total, 7 (7%) patients required revisions. Reasons were pain (1 VV, 2 NV), erosion (1 NV), voiding dysfunction (1VV, 1 NV), and sling failure (1 VV). Subjective success rates were similar with no significant differences at 1, 3, 6, and 12 months (91%, 94%, 100%, and 100 % for VV and 88%, 88%, 100%, and 93% for NV). At one month, VV had smaller change in postoperative pad use (-1.2 vs. -2.8, p=0.04), IIQ-7 (-5 vs. -12, p=0.0001), and UDI-6 (-4 vs. -8, p=0.01), but there were no significant differences in these parameters between VV and NV at 3, 6, and 12 months. CONCLUSIONS In women with valsalva voiding, RPS appear to be a safe and effective treatment for SUI. Between VV and NV, no differences were seen in success rate, postoperative voiding dysfunction, complication rate, or revision rate. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e345 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Blake Anderson More articles by this author David Hatcher More articles by this author Rena Malik More articles by this author Jessica Volsky More articles by this author Gregory Bales More articles by this author Doreen Chung More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...