Postoperative voiding dysfunction following posterior colporrhaphy.

OBJECTIVE: The primary objective of this study was to evaluate the rate of postoperative urinary retention in patients undergoing posterior colporrhaphy. This is compared with the rate of postoperative urinary retention in patients undergoing suburethral sling placement. METHODS: A retrospective analysis of women treated surgically for either a symptomatic posterior compartment defect or stress urinary incontinence was performed. The preoperative, operative, and postoperative records of women who underwent a sole procedure of a posterior colporrhaphy or tension-free suburethral sling by 2 fellowship-trained urogynecologists were reviewed and compared. RESULTS: Significantly more posterior colporrhaphy patients failed their voiding trial (32.4% ± 12%) than suburethral sling patients (15% ± 17%; P = 0.030). After replacement of a Foley catheter, the total length of catheterization was longer in the posterior colporrhaphy group (3.2 ± 0.9 days) than that in the suburethral sling group (1.8 ± 0.4 days; P = 0.007). No patients in either group demonstrated long-term voiding dysfunction, and no patients required further surgical management to reverse their transient voiding dysfunction. CONCLUSIONS: In this study, the rate of postoperative transient urinary retention following posterior colporrhaphy is 32.4%, which is significantly higher than the rate observed following suburethral sling placement. Although the reason for this higher rate is unclear, it may be related to postoperative pain. Although it is standard practice to assess voiding function after suburethral sling placement, the findings of our study suggest that physicians should also consider assessing postoperative voiding function following posterior colporrhaphy.

Comparison of 2 techniques to predict voiding efficiency after inpatient urogynecologic surgery.

PURPOSE: We compared 2 techniques used to assess adequate postoperative bladder emptying. MATERIALS AND METHODS: We performed a prospective, randomized, crossover study of 2 voiding trial techniques. 1) For back fill the bladder is filled with 300 cc saline before the Foley catheter is removed. 2) For auto fill the catheter is removed and the bladder is allowed to fill spontaneously. Patients were randomized into 2 groups for voiding trials, including group 1-auto fill followed by back fill or group 2-back fill followed by auto fill. Within 15 minutes of each void we measured post-void residual urine by straight catheterization. A void of two-thirds or greater of total bladder volume (voided volume plus post-void residual urine) at void 2 of the 2 voids was considered successful voiding. Patients who voided successfully were discharged home without a urethral catheter. We used the chi-square test with κ to determine successful bladder emptying. RESULTS: We recruited 79 patients, of whom 65 with a mean age of 59.7 years (range 33 to 81) had complete data sets available for analysis. Of the patients 38 (58%) underwent prolapse repair only, 1 (2%) underwent a continence procedure only and 26 (40%) underwent each procedure. The back fill void trial correlated better with a successful voiding trial than the auto fill trial (κ = 0.91, 95% CI 0.81-1.00 vs κ = 0.56, 95% CI 0.39-0.74). Overall 40.5% of patients had an unsuccessful void trial on day 1 postoperatively and were discharged home with a catheter. None subsequently experienced urinary retention. CONCLUSIONS: The back fill technique appears to be a better predictor of adequate postoperative bladder emptying than the auto fill technique for inpatient void trials.

Urodynamic prediction of occult stress urinary incontinence before vaginal surgery for advanced pelvic organ prolapse: evaluation of postoperative outcomes.

OBJECTIVES: : To evaluate the use of urodynamics for assessment of occult stress urinary incontinence (SUI) in women undergoing vaginal surgery for advanced pelvic organ prolapse (POP). METHODS: : Retrospective chart review of women who underwent vaginal surgery for advanced POP at the University of Rochester Medical Center. RESULTS: : The study sample was composed of 41 women (mean age: 65.6 years; range: 42-88 years). Prolapse was stage 3 or 4 in 40 (97.6%) women. Urodynamics identified 17 (41.5%) women with occult SUI. Postoperatively, 3 (7.3%) women reported urinary incontinence: 1 with stress and 2 with urge-related symptoms. The woman with postoperative SUI had been diagnosed with occult SUI, but declined continence repair. None of the women without occult SUI on urodynamics reported postoperative SUI. CONCLUSIONS: : Urodynamic evaluation prior to vaginal surgery for advanced POP can identify women at risk for SUI, who may benefit from concomitant continence repair.

Urinary incontinence secondary to severe labial agglutination.

The purpose of the study was to describe the presentation and management of urinary incontinence because of severe labial adhesions. Records of all patients diagnosed with labial agglutination and urinary incontinence at the Division of Gynecologic Specialties between January 1999 and February 2006 were reviewed. Clinical presentation, management, and treatment outcome were extracted from the records. Five subjects were identified. Mean age was 78 (range 59-87) years. Four subjects presented with mixed and one with urge urinary incontinence. Four reported change in flow of stream with voiding. Physical examination showed near-total occlusion of the introitus and urethral meatus in four subjects and partial occlusion in one subject. All were treated topically with estrogen and/or steroids. None of the subjects improved with conservative management, and all required lysis of the labial adhesions. Postoperatively, all were treated with daily topical estrogen and three with concurrent topical steroids. All subjects reported resolution of voiding dysfunction; three had complete resolution of their incontinence. Lysis of labial adhesions combined with postoperative topical estrogen and steroids appears to be an effective treatment in women with this condition.