TVT, Burch, and Slings: Are There Predictors for Early Postoperative Voiding Dysfunction?

V. A. Minassian, MD, A. Al-Badr, MBBS, H. P. Drutz, MD, S. J. Ross, PhD, D. Lovatsis, MD. University of Toronto, Toronto, Ontario, Canada

   Objectives: The purpose of this study was to compare the rate, duration, and risk factors of early postoperative voiding dysfunction after three different incontinence operations.

   Methods: The charts of all women with stress urinary incontinence undergoing a TVT, Burch, or combined abdominovaginal sling at the Mount Sinai Hospital, Toronto, Ontario, between January 1999 to December 2001 were reviewed. Early postoperative voiding dysfunction was defined as inability to void or high postvoid residual (PVR>200cc) at the time of discharge from hospital. Analyses of variance (ANOVA), Chi-square, and Mann-Whitney U statistical tests were used with P < 0.05 as cut-off for significance.

   Results: 138 patients, 63(46%) TVT, 42(30%) Burch, and 33(24%) slings were identified. The TVT, Burch, sling groups were similar in mean age (61, 59, 60), median parity (3, 3, 3), weight in kg (74.1, 71.0, 71.8), preoperative PVR in cc (56, 83, 74), maximum cystometric capacity in cm (497, 480, 466), and functional urethral length in cm (2.4, 2.4, 2.5) (P=0.17). 31(94%) sling patients were postmenopausal compared to 30(71%) Burch and 45(71%) TVT (P=0.03). 31(94%) sling patients had previous incontinence surgery compared to 11(26%) Burch and 6(10%) TVT (P<0.001). Although Burch patients had higher preoperative maximum urethral closure pressure compared to sling and TVT (45, 35, and 35cm of H2O respectively, P=0.05), and lower maximum flow rates (22, 23, and 29cc/sec respectively, P=0.01), the incidence of early postoperative voiding dysfunction was highest with TVT (50%) followed by sling (24%) and Burch (15%) (P<0.001). The need for prolonged catheterization was highest with t! he sling (21 days) followed by TVT (9 days) and Burch (5 days). Patients with early postoperative voiding dysfunction compared to those with normal voiding pattern had significantly smaller preoperative PVR (50 vs. 75cc respectively, P=0.05), more days with bladder drainage (29 vs. 3 days respectively, P<0.001), and higher rate of urinary tract infections (UTI’s) (43% vs. 15% respectively, P<0.001).

   Conclusion: Early postoperative voiding dysfunction remains an underreported but frequent postoperative complication. Its high incidence after a sling can be explained by the fact that the majority of patients had previous incontinence procedures. It is unclear why TVT patients have a high incidence of early postoperative voiding dysfunction.

   Key Words: TVT, Burch, sling, stress urinary incontinence, postoperative voiding dysfunction.