Significance of cystoscopic bladder trabeculations in women undergoing midurethral sling.
BACKGROUND
To determine the significance of bladder trabeculations seen on preoperative cystoscopy prior to midurethral sling surgery with respect to lower urinary tract symptoms and sling outcomes.


METHODS
This retrospective study included women with preoperative cystoscopy who underwent midurethral slings for urinary incontinence from 2006-2009. Cystoscopic findings of bladder trabeculations, as well as pre and postoperative urinary symptoms were recorded. Patients with and without bladder trabeculations were compared with respect to baseline characteristics, lower urinary tract symptoms, and sling outcomes.


RESULTS
Of the 241 women included in the study, 14.9% had trabeculations on preoperative cystoscopy. At baseline, women with trabeculations were more likely to be older (64.8 years versus 57.8 years, p < 0.01), and have lower mean maximum cystometric capacity (341 mL +/- 136 versus 436 mL +/- 148, p < 0.01), compared to those without trabeculations. More women with trabeculations had mixed incontinence (p < 0.01) and less pure stress incontinence (p < 0.01) preoperatively. There was no difference between women with and without trabeculations with respect to pre and postoperative symptoms of urgency, frequency, and nocturia. Women with preoperative trabeculations were more likely to have preoperative treatment with anticholinergics (p = 0.02) and had a three times higher risk of postoperative sling failure (HR 2.95 [CI 1.11-7.85], p = 0.03).


CONCLUSIONS
Preoperative cystoscopic bladder trabeculations are associated with significantly higher rate of midurethral sling failure. Trabeculations were not associated with pre or postoperative lower urinary tract symptoms.
Section of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center/ Georgetown University School of Medicine, Washington, DC, USA.
Ladin A
LA
Yurteri-Kaplan
Danielle D
DD
Antosh
Cheryl B
CB
Iglesia
Andrew I
AI
Sokol
David
D
Shveiky
Robert E
RE
Gutman
D000367:Age Factors; D000368:Aged; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003558:Cystoscopy; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000150:complications; D008875:Middle Aged; D009130:Muscle, Smooth / Q000473:pathology*; D009929:Organ Size; D057234:Preoperative Period; D011475:Prosthesis Failure; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology*; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000601:surgery*; D053202:Urinary Incontinence, Urge / Q000150:complications / Q000601:surgery*
D018680:Cholinergic Antagonists