Gynecology & Obstetrics
Open Access

Abstract

Impaired Detrusor Contractility and the Treatment of Female Stress Urinary Incontinence

Rose Khavari, Kumaran Sathyamoorthy, Jonathan Zurawin, Robert Chan, Ricardo Gonzalez and Sophie Fletcher

Introduction and hypothesis: Little conclusive data exists regarding Urodynamic (UD) variables predictive of voiding dysfunction after synthetic Midurethral Sling (MUS) placement. This study aims to evaluate outcomes of MUS in female patients with Impaired Detrusor Contractility (IDC), Valsalva Voiding (VV), or both. We propose that there would be no direct relationship between these variables and urinary retention requiring Clean Intermittent Catheterization (CIC) or reoperation at 6 wk follow up.
Methods: Retrospective chart review was performed for all MUS procedures at a single institution, 1/2010- present. Subjects with complete pre-operative UD records and 6 wk follow up were included. The primary outcome measure was urinary retention requiring CIC or re-operation at 6 wk follow up.
Results: 187 women who underwent MUS from January 2010 to present had complete UD and ≥ 6 wk follow up data. Average age was 56.7 years. Pre-operative UD identified 64 (34.2%) IDC subjects. At 6-wk follow up, no new subjects in this group required CIC for obstruction or reoperation. No subjects without IDC required CIC or reoperation for urinary retention; however there were 2 reoperations in this group: persistent stress incontinence and vaginal extrusion. Pre-operative UD identified 50 (26.7%) VV subjects. One patient in this group required reoperation; however sling removal was for vaginal extrusion. In the group with both IDC and VV (n=23) no subjects required reoperation.
Conclusions: Neither IDC nor VV appear to be risk factors for post-operative urinary retention or reoperation after MUS and have little predictive value for outcomes after MUS.