Poster, Podium & Video Sessions
Presentation Authors: Alyssa Greiman*, Lauren Rittenberg, Lindsey Cox, Ross Rames, Eric Rovner, Charleston, SC
Introduction: The risk factors for urinary retention (UR) after sling in women with detrusor underactivity (DU)/Valsalva voiding is not well established. There is limited evidence that increasing outlet resistance in those with poor contractility would be a risk factor for urinary retention (UR). Symptoms of DU are often manifest as hesitancy and straining during the voiding phase and urodynamics (UDS) may overestimate this condition due to a number of factors during UDS including: psychogenic inhibition and pain from urethral catheterization. This study examined UR after sling in patients with or without DU/Valsalva voiding to determine if the reproduction of voiding symptoms on UDS in those with DU is predictive of UR after sling.
Methods: Following IRB approval, we performed a review of patients undergoing sling looking specifically at the occurrence of short and long term urinary retention. Preoperative incontinence symptom score questionnaire and UDS data were obtained from a prospective UDS database in which patients are directly queried at the time of the UDS study whether the filling/storage, and voiding phases of the study reproduced their usual symptoms. Urinary retention was defined as failed void trial requiring prolonged suprapubic catheter drainage or initiation of intermittent catheterization and was assessed at 1 week, 1 month and 3 months.
Results: Of the 96 women who had a sling procedure, 77 (80%) had preoperative UDS. Of those who had UDS, 27 (43%) had de-novo UR at some point post-operatively; 5 at 1 week, 7 at 1 month, and 15 at 3 months or longer. 26/27 (96.3%) patients who had UR had APVS versus MUS sling. As compared to those without DU, patients with DU were more likely to have UR (81% vs 56%, p=0.025). A positive symptom score of incomplete emptying did not increase risk of UR (p=0.58). 63/77 (82%) patients had UDS which reproduced their voiding symptoms, 23 (37%) of whom had UR. There was no difference in risk of UR in patients with DU/Valsalva voiding whose UDS reproduced voiding symptoms compared to those with DU/Valsalva voiding whose UDS did not reproduce symptoms (OR 0.98, CI 0.23-4.18, p= 0.98).
Conclusions: Patients with DU/Valsalva voiding have an increased risk of UR following sling, however reproduction of symptoms on UDS or symptom score do not correlate with risk of UR in either those with DU/Valsalva voiding or those with normal bladder contractility.
Source Of Funding: none
Medical University of South Carolina
Alyssa Greiman is a PGY3 Urology Resident at the Medical University of South Carolina in Charleston, SC. She received her Bachelor of Science degree at Northwestern University in 2009 and then completed her medical school training at Feinberg School of Medicine, Northwestern University in 2014. She plans on pursuing a fellowship in Female Pelvic Medicine and Reconstructive Surgery after completing her residency training.
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