Uroflow Changes Following Mid-Urethral Sling (MUS) Procedure

Author Type(s)

Faculty, Resident/Fellow

Document Type

Abstract

Publication Date

2022

DOI

10.1007/s00192-022-05295-2

Journal Title

International Urogynecology Journal

Department

Obstetrics and Gynecology

Second Department

Urology

Abstract

Introduction: Stress urinary incontinence (SUI) and its treatments can greatly impact quality of life. (1) In current literature, some women who underwent SUI operations were found to develop obstructive symptoms or voiding dysfunction, with a reported incidence of 2-25% of cases following MUS procedures. (2-3) Assessment of urine flow pattern before and after surgery can potentially provide valuable information of the changes that MUS operations pose. (4) There is limited evidence describing predictive values of uroflowmetry changes on voiding function after sling placement, however this could improve procedural outcomes and patient satisfaction. (5) Investigating uroflow pattern changes due to MUS procedures can potentially identify predictors of post-operative success and adverse outcomes, such as voiding dysfunction or overactive bladder. (5-9) We hypothesized that even slings deemed to be successful have an impact on the flow of the urinary stream. Objective: To investigate the changes in uroflowmetry parameters following retropubic MUS sling. Methods: Eligible subjects included women undergoing MUS with pre-and post-operative uroflowmetry (max flow, voiding pattern, post void residual) and UDI-6 data. Uroflowmetry was considered adequate if voided volumes were greater than or equal to 150 mL. Continuous data was reported as medians (ranges) and comparisons made with Wilcoxan Rank test. Categorical data was reported as counts (percentages) and compared with McNemar's test. Results: 17 patients underwent retropubic MUS sling with median 2.5 (0.3 to 114) weeks follow-up and met eligibility criteria. 8/17 (47%) had concomitant prolapse surgeries. 6/17 (35%) were discharged home with a Foley and 4/17 (24%) had a post-op UTI during their follow up period. Overall, median maximum flow significantly decreased after sling surgery [24 mL/s (9-48) vs 15 ml/s (6-33), p<0.001], while PVR was not significantly different after surgery [30 mL (5-210) vs 63 mL (0-750), p= 0.19]. Patients symptomatically improved on UDI-6 after surgery when compared with pre-op values (11 vs 2, p=0.02). No patients needed a sling revision in the first 12 weeks and 1 patient had a sling revision over 2 years later for persistent elevated PVRs and urgency incontinence. Conclusions: Retropubic MUS slings do significantly impact maximum flow (and flow pattern) on uroflowmetry, but with no significant difference in post-void residual. This is important information, as we can counsel patients that successful slings are likely to slow their urine stream but that objective emptying parameters remain normal.

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