OBJECTIVE - To compare outcomes after retropubic sling (RPS) in women with and without Valsalva voiding.
METHODS - Women who underwent RPS for stress incontinence from 2010-2014 were identified and their baseline characteristics were examined.
Valsalva voiding was defined as abdominal straining throughout voiding on preoperative urodynamics (UDS). Sub-analysis of those with Valsalva included a subset with detrusor underactivity (DU) on UDS. Follow-up was at 1, 3, 6 and 12 months. Primary outcomes were rates of subjective success, revisions, complications and voiding dysfunction. Secondary measures were Urogenital Distress Inventory (UDI-6) score, Incontinence Impact Questionnaire (IIQ-7) score, post-void residual (PVR) and pad use.
RESULTS - Subjects (n=141) analyzed included 75 Valsalva voiders (VV) and 66 non-Valsalva voiders (NV). At baseline, there were no differences in age, race, comorbidity, PVR, pad use, UDI-6 or capacity. Postoperatively, there were no differences in rates of passing initial void trial, need for clean intermittent catheterization, revisions, complications or voiding dysfunction. No differences in pad use, UDI-6 or IIQ-7 were seen at 6 or 12 months. Within VV, no differences between patients with and without DU were seen for any primary or secondary outcomes (all p > 0. 05).
CONCLUSIONS - In patients who void with Valsalva, RPS appears to be safe and effective. Between VV and NV, there were no differences in rates of subjective success, revisions or complications, even in patients with Valsalva voiding without appreciable detrusor contraction.
Urology. 2016 Feb 12 [Epub ahead of print]
Blake B Anderson, Joseph J Pariser, Shane M Pearce, Jessica Volsky, Gregory T Bales, Doreen E Chung
Section of Urology, Department of Surgery, University of Chicago, Chicago, Illinois. Section of Urology, Department of Surgery, University of Chicago, Chicago, Illinois. Section of Urology, Department of Surgery, University of Chicago, Chicago, Illinois. Department of OB/GYN, Mount Sinai Hospital, Chicago, Illinois. Section of Urology, Department of Surgery, University of Chicago, Chicago, Illinois. uchicago. edu. , Department of Urology, Columbia University, New York, New York.