Risk Factors Predicting Voiding Difficulty Following Tension-Free Vaginal Tape Procedure

ABSTRACT

PURPOSE: Among complications after the tension-free vaginal tape(TVT) procedure for female stress urinary incontinence, the voiding dysfunction is one of the most common complaints of the patients. The aim of the study was to assess the incidence of objective voiding dysfunction and evaluate the clinical, uroflometric and urodynamic risk factors predisposing to voiding dysfunction following the TVT procedure. MATERIALS AND METHODS: 437 women with stress urinary incontinence underwent the TVT procedure in our institution for recent three years. Among them, 285 patients with post-operative uroflowmetry were evaluated. Objective voiding dysfunction was defined as a peak-flow rate less than 12 ml/sec(voided volume greater than 100 ml), or inability to void at least 75% of bladder capacity, on two or more readings. Clinical and urodynamic parameters and global satisfaction were analyzed and compared between patients(objective voiding dysfunction, n=33, 11.6%) who had uroflowmetric parameters of voiding difficulties after TVT procedure and patients(well- voiding, n=252, 88.4%) who had not. RESULTS: Two hundred sixty-one patients (91.6%) answered satisfied by global satisfaction questionnaire. Subjective and objective cure rates were 93.9% and 90.9% at least 6 months follow-up. Among parameters, patient's age, peak-flow rate, and 1 hour pad test showed significant differences between voiding dysfunction group and well-voiding group(average age: 54.9 vs 50.9 years-old, p=0.024, peak urinary flow rate: 30.9 vs 24.1 ml/sec, p=0.003, 1 hour pad test: 53.8 vs 81.6 gm, p=0.035). There was no statistically significant difference in subjective and objective cure rates and satisfaction rates between the two groups. CONCLUSIONS: Women with the old age, low peak urinary flow rate, and large volume with 1 hour pad test are most likely to have voiding dysfunction after TVT procedure. Patients with these risk factors should be given more counsel regarding post-operative voiding dysfunction before the surgery.