Early postoperative voiding dysfunction after insertion of retropubic midurethral tape.

INTRODUCTION AND HYPOTHESIS: A significant proportion of patients develop voiding dysfunction after midurethral tape (MUT) insertion, which reduces patient satisfaction. The study's purpose was to identify predictive factors of voiding dysfunction after a retropubic MUT procedure. METHODS: This was a retrospective study of 100 patients who underwent only a retropubic MUT procedure between January 2010 and December 2011. Early voiding dysfunction was defined when patients required a Foley catheter within 48 h. Data including demographic information, urogenital symptoms, previous surgery, preoperative uroflowmetry and urodynamic parameters were analysed using SPSS v22. Univariate analysis of all demographic variables was performed; those significant at 10 % were entered into a multivariate logistic regression. RESULTS: Fourteen patients required Foley catheter insertion, with a median age of 58 years (26-83 years), median BMI 28 kg/m(2) (20-48 kg/m2), and median parity 2 (0-4). Univariate analysis revealed peak flow rate <15 ml/s (OR 3.79; 1.07, 13.4; p = 0.046), bladder capacity (p = 0.044), stress incontinence versus mixed or urge incontinence (p = 0.064) and previous surgery (OR 4.39; 1.34, 14.41; p = 0.015) to be associated with voiding dysfunction. Multivariate analysis showed only previous pelvic floor surgery to be independently associated (OR 3.76; 1.14, 12.23, p = 0.029). CONCLUSIONS: Only previous pelvic-floor surgery was found to be a strong predictive factor of voiding dysfunction. The rate of voiding dysfunction was similar to those of published data. Previous studies revealed different predictive factors. A larger cohort is needed to provide a definite answer. Those with previous surgery appear to be those most at risk and pre-surgical counselling for these women could be suggested.

Safety and one year outcomes following vaginally assisted laparoscopic uterine sacropexy (VALUES) for advanced uterine prolapse.

AIMS: To assess the safety and outcomes of vaginally assisted laparoscopic uterine sacropexy (VALUES) as a surgical treatment for stage 3 and 4 uterine prolapse. METHODS: Seventy consecutive women with stage 3 and 4 uterine prolapse who underwent VALUES over 2-year period were prospectively evaluated. Women filled the Prolapse Quality of Life Questionnaire (P-QOL), and underwent examination using pelvic organ prolapse quantification system (POP-Q) pre- and post-operatively. In addition, patients filled the patient global impression of improvement questionnaire post-operatively. Mesh related complications were evaluated post-operatively. Patients were followed up at 3 and 12 months following surgery. This study reports the 12 months outcomes. RESULTS: Sixty-four women (91.4%) reported cure of their prolapse symptoms. On examination, 67 women (95.7%) had POP-Q stage 0 or 1 uterine support at 12 months. Six women needed further surgical intervention for prolapse (8.5%); three women developed recurrent uterine prolapse and three other women developed symptomatic recurrent anterior vaginal wall prolapse. The total vaginal length was not different between the pre- and post-operative periods. Two patients developed mesh related complications. Significant improvement was noted in prolapse symptoms and quality of life. CONCLUSIONS: VALUES is a safe and effective treatment for women with stage 3 and 4 uterine prolapse up to 12 months without the risk of vaginal shortening. Long-term results are needed to fully establish the value of this technique.