title: Analysis of voiding dysfunction after transobturator tape procedure for stress urinary incontinence.
abstract: OBJECTIVE
  The definition of posttransobturator tape procedure (post-TOT) voiding dysfunction (VD) is inconsistent in the literature. In this study, we retrospectively investigated the risk factors for post-TOT VD by applying various definitions in one cohort.
  
  
  METHODS
  The medical records of 449 patients were evaluated postoperatively. Acute urinary retention requiring catheterization, subjective feeling of voiding difficulty during follow-up, and postoperative postvoid residual (PVR) greater than 100 mL or PVR greater than 50% of voided volume (significant PVR) were adopted for the definition of VD. With these categories, multivariate analysis was performed for risk factors of postoperative VD.
  
  
  RESULTS
  Ten patients (2.2%) required catheterization, 47 (10.5%) experienced postoperative voiding difficulty, and 63 (14.7%) showed significant PVR. In the multivariate logistic analysis, independent risk factors for postoperative retention requiring catheterization were previous retention history (p=0.06) and preoperative history of hysterectomy. Risk factors for subjective postoperative voiding difficulty were underactive detrusor (p=0.04) and preoperative obstructive voiding symptoms (p<0.01). Previous urinary retention history (p<0.01)) was an independent risk factor for concomitant postoperative voiding difficulty and significant PVR. Spinal anesthesia (p=0.02) and previous urinary retention history (p=0.02) were independent risk factors for significant postoperative PVR.
  
  
  CONCLUSIONS
  With the use of several definitions of VD after the midurethral sling procedure, postoperative peak flow rate and PVR were significantly different between groups. Although there were no independent risk factors consistent with various definitions of VD, preoperative obstructive voiding symptoms and objective parameters suggesting impaired detrusor tend to have predictive power for post-TOT VD.
authors.affiliation: Department of Urology, Dongguk University Ilsan Hospital, Goyang, Korea.
authors.forename: Chang
authors.initials: C
authors.lastname: Ahn
authors.affiliation: Department of Urology, Dongguk University Ilsan Hospital, Goyang, Korea.
authors.forename: Jungbum
authors.initials: J
authors.lastname: Bae
authors.affiliation: Department of Urology, Dongguk University Ilsan Hospital, Goyang, Korea.
authors.forename: Kwang Soo
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Department of Urology, Dongguk University Ilsan Hospital, Goyang, Korea.
authors.forename: Hae Won
authors.initials: HW
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D053825:Suburethral Slings / Q000009:adverse effects*; D014546:Urinary Catheterization; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000601:surgery*; D016055:Urinary Retention / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D014563:Urodynamics
keywords: Suburethral slings; Urethral obstruction; Urinary incontinence; Urodynamics