IMMEDIATE URINARY RETENTION AFTER MINIMALLY-INVASIVE SLING: CAN WE PREDICT IT?

K.I. Barron, J.A. Savageau, A.N. Morse

University of Massachusetts Memorial Medical Center, Worcester, MA

OBJECTIVE: To investigate factors predictive of immediate post-operative urinary retention after outpatient, minimally-invasive sling (MIS).

MATERIALS AND METHODS:  We reviewed the charts of all MIS procedures at UMass Memorial facilities from January, 2001 through June 2004.  126 patients who underwent an outpatient procedure including an MIS were identified.  Information on immediate post-operative voiding function was available for 119(94%) of these women.  The median age of the subjects was 53 (Range 30-85).  The Tension-free Vaginal Tape (Gynecare) was performed in a standard fashion utilizing the vaginal to suprapubic technique.  Patients who did not meet the criteria for discharge without catheterization (PVR <150 and <50% of pre-void bladder volume), were sent home with an indwelling Foley catheter or performed intermittent self-catheterization if taught pre-operatively. Logistic regression analysis modeled the relationship of factors significant at the bivariate level (p<0.2) with normal post-operative voiding as the dependent variable, controlling for patient age.  Initial independent variables tested included demographics, preoperative urodynamic parameters, perioperative variables and concomitant procedures.

RESULTS:  61% (73/119) of the patients passed their immediate post-operative voiding trial.  The incidence of urinary retention lasting > 14 days was 2% (2/118).  Subjective success rate at 6-12 weeks was 93% (104/112).  Surgeon [chi-squared(2)= 3.3, p=.19], parity>2[chi-squared(1)= 2.15, p=.14], high anxiety level in the holding area [chi-squared(1) = 5.3, p=.02], and valsalva leak point pressure (VLPP)>60 [chi-squared (1)=6.6, p=.01] demonstrated an independent association with successful post-operative voiding (p<0.2) in bivariate comparisons.  Age, BMI, additional procedures, pre-admission anxiety level, continence outcome, and post-operative opiate administration were not significantly associated with successful immediate post-operative voiding.  After logistic regression, parity>2(OR 5.1, p=.034, 95% CI=1.4-18.9); high holding area anxiety (OR 5.8, p=.02, 95% CI=1.5-23.2); and VLPP>60 (OR 7.4, p=.008, 95%CI=2.0-27.3) remained significantly associated with successful immediate post-operative voiding trial.

CONCLUSIONS:  In this cross sectional study, approximately 60% of our patients met the criteria for discharge without catheterization on the day of their MIS procedure.  Regression analysis suggests that higher parity, higher immediate pre-operative anxiety and VLPP>60 may be associated with greater likelihood of passing the immediate post-operative voiding trial.  These associations may be useful in predicting which patients are likely to void spontaneously and which are more likely to require catheterization after MIS, thus helping to accurately shape patient expectations and identify those most likely to benefit from pre-op intermittent self-cath teaching.  The next step in this research will be to create a “likelihood of post-op voiding” score based on the pre-operative parameters and test its predictive value prospectively in our practice.

Key Words: TVT, Urinary incontinence, urinary retention, minimally-invasive sling

Disclosure – Nothing to disclose.