The objectives of this study are to review patients with chronic urinary symptoms and remote urethral sling surgery to determine the prevalence and predictors of obstruction.
A single-center retrospective review was performed on patients referred with chronic lower urinary tract symptoms (>6 months) and a history of urethral sling surgery. Obstruction was identified by urodynamics using the Blaivas criteria or fluoroscopy. Clinical findings for patients with and without obstruction were compared. Logistic regression was applied to identify predictors of urodynamic obstruction. The need for sling revision and post-revision outcomes were evaluated.
In total 105 patients were included, median age 61 years (IQR 19), median time since sling surgery 5.0 years (IQR 8). Sixty percent (63/105) met the definition for obstruction. Patients with obstruction had higher mean PDet@Qmax (35 vs 19 cmH2O) and lower Q max (6.0 vs 14 mL/s) (P<.05). A tight sub-urethral band and increased post-void residuals were significantly associated with urodynamic obstruction (P<.05). Fifty-nine (59/105; 56%) patients underwent sub-urethral sling excision. The incidence of improvement in storage and voiding symptoms at 6-months was 43% and 87% respectively. At 30 months post-excision, the probability of being incontinence-free was 56% (95% CI 41%, 69%) and the probability of being free from redo sling-surgery was 75% (95% CI 55%, 87%).
Obstruction is common in patients with chronic urinary symptoms and history of urethral sling surgery. Patients undergoing sling revision should be observed for persistent storage symptoms and recurrent incontinence.
The Journal of urology. 2022 Nov 17 [Epub ahead of print]
James Ross, Lidia Avvakoumova, Alaya Yassein, Magdalene Payne, Conrad Maciejewski, Ranjeeta Mallick, Rodney H Breau, Humberto Vigil, Duane Hickling
Department of Surgery, Division of Urology, University of Ottawa, Ottawa, Ontario, Canada., Department of Surgery, Division of Urology, Halton Health, Georgetown, Ontario, Canada., Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada., The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.