title: Preoperative urodynamic evaluation may predict voiding dysfunction in women undergoing pubovaginal sling.
abstract: OBJECTIVE
  We determine which urodynamic parameters can best predict postoperative voiding dysfunction following pubovaginal sling surgery.
  
  
  METHODS
  The records of 98 consecutive women who had undergone pubovaginal sling surgery with allograft fascia lata between July 1998 and July 2000 were reviewed. Urodynamic and followup data were sufficient for evaluation for 73 patients. Urodynamic and clinical parameters were correlated with urinary retention, time to return of efficient voiding and development of postoperative urgency symptoms.
  
  
  RESULTS
  Average time to return of efficient voiding was 3.92 days (median 3). Of 21 women who voided without a detrusor contraction urinary retention developed in 4 (23%) versus 0 of 48 who voided with detrusor contraction (p = 0.007). Urinary retention was defined as the need to perform even occasional self-catheterization. All 4 women with urinary retention had a detrusor pressure of less than 12 cm. H(2)O (0 in 3, 4 in 1). None of the women with a detrusor pressure of greater than 12 cm. H(2)O had urinary retention (p = 0.047). The presence of Valsalva voiding in women without a detrusor contraction did not affect the incidence of urinary retention (11.1%) compared to those who did not demonstrate Valsalva voiding (5.1%) (p = 0.603). Peak flow rate, detrusor instability on preoperative urodynamics and post-void residual urine volume were not associated with postoperative urinary retention. Finally, post-void residual urine volume predicted delayed return to normal voiding (p = 0.001). There were no other urodynamic parameters that were significantly associated with urinary retention, delayed return to normal voiding or postoperative urgency symptoms including peak flow rate, capacity or compliance.
  
  
  CONCLUSIONS
  Women who void without or with a weak detrusor contraction are most likely to have urinary retention postoperatively. Therefore, we conclude that preoperative urodynamic evaluation may be used to counsel women regarding the risk of urinary retention following the pubovaginal sling procedure.
authors.affiliation: Department of Urology, University of Washington Medical Center, Seattle, Washington, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Miller
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Amundsen
authors.forename: Khai Lee
authors.initials: KL
authors.lastname: Toh
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Flynn
authors.forename: George D
authors.initials: GD
authors.lastname: Webster
mesh_terms: D005206:Fascia Lata / Q000637:transplantation; D005260:Female; D006801:Humans; D008875:Middle Aged; D009119:Muscle Contraction; D011183:Postoperative Complications; D012008:Recurrence; D014184:Transplantation, Homologous; D001743:Urinary Bladder / Q000503:physiopathology; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000601:surgery*; D016055:Urinary Retention / Q000175:diagnosis / Q000209:etiology*; D014554:Urination; D014563:Urodynamics; D014636:Valsalva Maneuver