RANCHO MIRAGE, CALIF. — Preoperative characteristics may help identify patients more or less likely to need catheterization for urinary retention immediately after minimally invasive sling surgery, said Abraham Morse, M.D.
Outpatients treated for urinary incontinence with the tension-free vaginal tape (TVT) system were studied retrospectively. Of the 119 cases, those who had a parity of at least three, were very anxious in the preoperative holding area, or had a normal Valsalva leak point pressure were less likely to require postoperative catheterization, Dr. Morse said at the annual meeting of the Society of Gynecologic Surgeons.
Dr. Morse of the University of Massachusetts, Worcester, and his associates hope to use these parameters to develop a scoring system for likelihood of postoperative voiding to better counsel patients before the TVT procedure.
“For [many] patients, the idea of going home on a catheter is a big issue …. If we could better predict who will be able to immediately void postoperatively, we [could] more effectively manage patient expectations and concerns, and identify those most likely to benefit from preoperative teaching of self-catheterization,” said Dr. Morse, who disclaimed any financial interest in Gynecare, which markets the TVT system.
A review of TVT cases over a 3.5-year period focused on 119 outpatient procedures and excluded outpatients with cystotomies, because they were discharged with Foley catheters in place. Nurses in the preoperative holding area asked patients to rate their anxiety on a 10-point scale, with 1 being the least anxious.
Overall, 39% failed an immediate postoperative voiding trial and needed some kind of catheterization to be discharged. Of the total, 28% were discharged with a Foley catheter, and 11% went home using intermittent self-catheterization. Eventually, two patients (2%) needed mesh sectioning to treat persistent urinary retention lasting longer than 2 weeks. These rates are similar to those in other reports in the literature, Dr. Morse said.
Patients with a parity of at least three were five times more likely to pass the postoperative voiding trial, compared with patients who had a lower parity, a logistic regression analysis showed. A normal Valsalva leak point pressure conferred a sevenfold greater likelihood of not needing catheterization, compared with those with abnormal pressures. Patients with high preoperative anxiety were six times more likely to pass the voiding trial, compared with less anxious patients, he said.
Immediate postoperative urinary retention is common after incontinence surgery. Two previous series of TVT procedures found that 45%–49% of patients required some catheterization at discharge, he said.
Patients in the current study had a mean age of 53 and a median parity of two. A majority of the women were menopausal. Preoperatively, 55% of patients had stress urinary incontinence only, 45% had mixed incontinence, 11% had detrusor instability, and 87% had urethral hypermobility. Six percent had undergone previous surgery for pelvic organ prolapse, and 12% had undergone surgery for incontinence. The procedures lasted a median of 42 minutes each.
The lead investigator in the study was Kim I. Barron, a medical student at the university.