PI-05 IS RETROPUBIC MID-URETHRAL SLING SAFE AND EFFECTIVE FOR PATIENTS WITH VALSALVA VOIDING?

Abstract

You have accessJournal of UrologyPlenary Session I - Best Abstracts1 Apr 2015PI-05 IS RETROPUBIC MID-URETHRAL SLING SAFE AND EFFECTIVE FOR PATIENTS WITH VALSALVA VOIDING? Blake Anderson, Joseph Pariser, Shane Pearce, Gregory Bales, and Doreen Chung Blake AndersonBlake Anderson More articles by this author , Joseph PariserJoseph Pariser More articles by this author , Shane PearceShane Pearce 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.2015.02.2933AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Due to the potential risk of voiding dysfunction after retropubic sling (RPS), there is concern regarding its use in women who void with Valsalva. The aim of this study was to compare outcomes after RPS in women with and without Valsalva voiding (VV). METHODS 141 women underwent RPS for stress incontinence from 2011-2014. Baseline demographics, urodynamics (UDS), operative and follow-up data were examined. VV was defined as abdominal straining throughout voiding on UDS. Analysis of those with VV included a subset with detrusor underactivity (DU) on UDS who had detrusor pressure <10 cm H2O or <20 sec contraction. Follow-up was at 1, 3, 6 and 12 months. Primary outcomes were subjective success rate (absence of stress incontinence with activity, coughing or sneezing), revision rate and complication (perioperative and 90-day) rate. Secondary measures were Urogenital Distress Inventory (UDI-6) score, Incontinence Impact Questionnaire (IIQ-7) score, post-void residual (PVR) and pad use. Tests of significance were Fisher's exact and t-tests. RESULTS Subjects included 75 Valsalva voiders (V) and 66 non-Valsalva voiders (N). At baseline, no differences were seen in age, race, comorbidity, PVR, pad use, UDI-6 or capacity. V had lower IIQ-7 (9.5 ± 6.6 vs. 12.6 ± 6.7, p=0.01) and more DU (23% vs. 5%, p<0.01) compared to N. No differences were seen in rates of passing initial void trial, clean intermittent catheterization, revisions, complications or voiding dysfunction. Revisions were for pain (1 V, 1 N), erosion (1 V, 4 N), voiding dysfunction (2 V, 3 N), sling migration (1 V) and sling failure (2 V, 1 N). Subjective success was similar out to 12 months (96% V vs. 92% N, p=0.6). At 6 and 12 months, there were no differences in pad use, UDI-6 or IIQ-7. For patients in V with and without DU, no differences were seen in rates of success, revisions, complications, voiding dysfunction or changes in UDI-6, IIQ-7, PVR or pad use. For V with DU, complications were 1 UTI, 1 asthma exacerbation, 1 voiding dysfunction and 1 pain. For V without DU, complications were 2 small cystotomies and 3 voiding dysfunctions. CONCLUSIONS In patients with VV, RPS appears to be safe and effective. Between V and N, no differences were seen in rates of subjective success, revisions, or complications, even for the subset of patients with VV and without appreciable detrusor contraction. Perioperative Outcomes, Complications and Revisions Parameter Non-Valsalva Voiders (N) Valsalva Voiders (V) p value Valsalva (-) DU Valsalva (+) DU p value n (%) 75 (53%) 66 (47%) 58 (77%) 17 (23%) Failed Initial Voiding Trial (%) 30 (45%) 29 (37%) 0.392 21 (36%) 7 (41%) 0.779 Catheter Time (days) 3.5 ± 3.1 2.9 ± 3.3 0.244 3.0 ± 3.4 2.4 ± 2.9 0.508 Clean Intermittent Catheterization Rate (%) 7 (11%) 7 (9%) ∼1.000 6 (10%) 1 (6%) ∼1.000 Revision Rate (%) 9 (14%) 7 (11%) 0.440 6 (12%) 1 (7%) ∼1.000 Complication Rate (%) 10 (15%) 9 (12%) 0.630 5 (9%) 4 (25%) 0.095 Clavien Grade (%) 0.062 0.074 1 4 (6%) 4 (5%) 3 (5%) 1 (6%) 2 1 (2%) 4 (5%) 1 (2%) 3 (18%) 3 5 (8%) 0 (0%) 0 (0%) 0 (0%) 4 0 (0%) 1 (1%) 1 (2%) 0 (0%) Voiding Dysfunction (%) 2 (3%) 4 (5%) 0.685 3 (5%) 1 (6%) ∼1.000 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e720 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Blake Anderson More articles by this author Joseph Pariser More articles by this author Shane Pearce 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 ...