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Risk Factors for Incomplete Bladder Emptying After Prolapse Repairs and Slings

Smithling, Katelyn R. MD; Mwesigwa, Patricia J. MD; Siddiquie, Moiuri M. MD, MPH; Gutman, Robert E. MD

Female Pelvic Medicine & Reconstructive Surgery: July 11, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000595
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Objective The aim of this study was to determine the risk factors for catheter use and incomplete bladder emptying (IE) more than 1 week after prolapse repairs and slings.

Methods This is a case-control study of women with prolapse repairs and/or sling from June 2011 to April 2016. All underwent standardized postoperative voiding trial before discharge. Controls and cases of IE were identified by codes and chart review; cases were defined as those needing any postoperative catheterization. We excluded patients with preoperative catheter use or postvoid residual (PVR) greater than 150 mL and those needing postoperative catheterization for reasons other than IE. Univariate and multivariate analyses were performed.

Results A total of 475 (30.6%) cases and 478 controls were identified from 1552 eligible patients. Any catheter use was associated with higher uroflow PVR (71.2 vs 54.1 mL, P = 0.006), lower uroflow maximum flow (19.4 vs 25.4 mL/s, P < 0.001), and less detrusor overactivity (DO) (22.0% vs 28.7%, P = 0.03). Seventy-seven (5.0%) patients used catheters more than 1 week, and 15 patients (1.5%) required sling revision.

Factors on multivariate analysis associated with any catheter use include office PVR [odds ratio (OR), 1.004; 1.00–1.008], uroflow maximum flow (OR, 0.96; 0.94–0.98), sling (OR, 2.40; 1.51–3.81), and anterior repair (OR, 1.81; 1.15–2.85). Factors associated with IE more than 1 week include uroflow maximum flow (OR, 0.90; 0.84–0.95), DO (OR, 0.21; 0.05–0.83), sling (OR, 3.68; 1.32–10.20), and uterosacral suspensions (OR, 3.43; 1.23–9.54).

Conclusions Overall, the incidence of short-term catheter use was 31%, prolonged IE more than 1 week was 5%, and 1.5% required sling revision. Sling placement, lower maximum flow, and higher preoperative PVR, anterior repair, and uterosacral ligament suspension are risk factors for IE, and presence of DO is protective.

From the MedStar Washington Hospital Center, South Washington, DC.

Correspondence: Katelyn Smithling, MD, 759 Chestnut Street, S1681 Springfield, MA 01107. E-mail: katelyn.smithlingmd@baystatehealth.org.

The authors have declared they have no conflicts of interest.

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