A prospective evaluation of the efficiency of early postoperative bladder emptying after the Stamey procedure or pubovaginal sling for stress urinary incontinence.
OBJECTIVE
The pubovaginal sling has been criticized as having a higher incidence of postoperative voiding dysfunction than other surgical approaches for the management of stress urinary incontinence. In 2 similar patient groups we prospectively compared the rates of early postoperative voiding dysfunction after the pubovaginal sling or Stamey procedure.


METHODS
Between June 1995 and January 1997, 50 consecutive patients underwent the pubovaginal sling or Stamey procedure. Emptying efficiency was measured 48 hours postoperatively by suprapubic catheter in the Stamey group and intermittent catheterization in the pubovaginal sling group. When emptying efficiency was greater than 75%, intermittent catheterization was stopped or the suprapubic catheter was removed.


RESULTS
There was no statistically significant difference in emptying efficiency for the first 3 voids using the Dunn multiple comparison method. Median voiding efficiencies were 37%, 43% and 61% with the Stamey procedure in group 1 (mean 43%, 45% and 54%), and 60%, 75% and 75% with the pubovaginal sling in group 2 (mean 49%, 68% and 69%), respectively. The mean number of intermittent catheterizations performed in patients with the pubovaginal sling was 5.7 in less than 1 day. In the Stamey group the suprapubic catheter was removed an average of 6 days postoperatively. The mean duration of hospital stay was similar for the sling and Stamey groups (5.4 versus 6 days, respectively). There were 2 patients in each group who were voiding inefficiently after day 7. Voiding efficiency was restored at 53 and 86 days in the 2 patients with slings and at 18 days in 1 of the 2 who underwent the Stamey procedure, respectively. The second patient who underwent the Stamey procedure was able to void without using the catheter at all, and it was removed 30 days postoperatively when emptying efficiency was confirmed greater than 75%.


CONCLUSIONS
These data show that early postoperative voiding dysfunction, measured using bladder emptying efficiency, after the pubovaginal sling is no more common than after the Stamey procedure and help justify the broadened indications for pubovaginal sling for treatment of stress urinary incontinence.
Brady
C M
CM
Department of Urology, Limerick Regional Hospital, Limerick, Ireland.
Ahmed
I
I
Drumm
J
J
Flood
H D
HD
D005260:Female; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D001743:Urinary Bladder / Q000503:physiopathology*; D014546:Urinary Catheterization; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000601:surgery*; D014554:Urination; D014555:Urination Disorders / Q000175:diagnosis / Q000209:etiology; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000379:methods