Int Neurourol J.  2017 Dec;21(4):282-288. 10.5213/inj.1734910.455.

Impact of Preoperative Patient Characteristics and Flow Rate on Failure, Early Complications, and Voiding Dysfunction After a Transobturator Tape Procedure: A Multicentre Study

Affiliations
  • 1Department of Urology, University of Florence, Florence, Italy.
  • 2Department of Urology, Polo Chirurgico “P. Confortini”, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. giovanni.cacciamani@gmail.com
  • 3Urology Institute, University of Southern California, Los Angeles, CA, USA.
  • 4Department of Urology, University of Catania, Catania, Italy.

Abstract

PURPOSE
To evaluate the impact of preoperative patient characteristics and flow rate on failure, early postoperative complications, and voiding in patients who underwent transvaginal tension-free vaginal tape-obturator (TVT-O) treatment for uncomplicated stress urinary incontinence (SUI).
METHODS
We retrospectively reviewed patients who underwent TVT-O for SUI at 3 Italian centres. The exclusion criteria were predominant voiding and storage symptoms suggestive of detrusor overactivity, the presence of grade >1 urogenital prolapse, previous pelvic radiotherapy or other clinical contraindications for surgical procedures, neurogenic bladder dysfunction, and collagen diseases. Multivariate logistic regression models were constructed to identify predictors of early voiding dysfunction after TVT-O.
RESULTS
A total of 219 patients underwent TVT-O between January 2010 and December 2015. All patients received follow-up at 3, 6, and 12 months, and underwent a stress test, uroflowmetry, and bladder ultrasound to evaluate the postvoid residual volume. They also responded to the Urogenital Distress Inventory (UDI-6) questionnaire. The rates of persistent incontinence after TVT-O, postoperative complications, and satisfaction were 16.4% (36 of 219), 24.2% (53 of 219), and 86.3% (189 of 219), respectively. Nineteen patients (9.5%) experienced early voiding dysfunction. Based on an analysis of baseline characteristics, we determined that a cutoff value of 9.0 on the UDI-6 predicted postoperative SUI with 62% specificity, 72% sensitivity, and 66% accuracy. In the multivariate logistic regression analysis, a preoperative UDI-6≥9.0 was an independent predictor of postoperative SUI. The predictors of complications were menopause (P = 0.04) and the preoperative UDI-6 score (P = 0.01).
CONCLUSIONS
Menopause and UDI-6 scores could be prognostic factors for persistent SUI after TVT-O. Well-designed prospective studies with a suitable number of patients are needed to corroborate our findings.

Keyword

Urinary Incontinence; Uretrhal Sling; Urinary Incontinence, Stress; Tension-Free Vaginal Tape; Urodynamics

MeSH Terms

Collagen Diseases
Exercise Test
Female
Follow-Up Studies
Humans
Logistic Models
Menopause
Pelvic Organ Prolapse
Postoperative Complications
Prospective Studies
Radiotherapy
Residual Volume
Retrospective Studies
Sensitivity and Specificity
Suburethral Slings*
Ultrasonography
Urinary Bladder
Urinary Bladder, Neurogenic
Urinary Incontinence
Urinary Incontinence, Stress
Urodynamics
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