title: Early voiding dysfunction after midurethral sling surgery: comparison of two management approaches.
abstract: OBJECTIVE
  Early voiding dysfunction (EVD) with urinary retention (UR) is a complication of midurethral sling (MUS) surgery. Management is not standardized. Our objective was to characterize management approaches at our center, and report outcomes including resolution of UR, persistent voiding dysfunction, and recurrent stress urinary incontinence (SUI).
  
  
  METHODS
  All women requiring catheterization for ≥7 days after MUS surgery during the period March 2014 to 2016 were eligible for inclusion in this prospective study. The management plan for each patient was decided jointly by the surgeon and the patient. Questionnaires regarding urinary symptoms were administered at enrollment, and 3 and 6 months after surgery. The timing and type of any surgical intervention were recorded.
  
  
  RESULTS
  During the 2-year period, 31 women experienced EVD for ≥7 days after MUS surgery. At 6 months, complete data were available for 30 women (97%). Two management approaches were identified: "early mobilization" to loosen the MUS intact (in 10 patients), and continued catheterization with delayed sling lysis as needed (in 21 patients). In eight of the ten women in the early mobilization group, UR resolved after one intervention. Two required a second mobilization. For all women in this group, UR resolved after one or two procedures. In 11 of the 21 women in the continued catheterization group UR resolved without intervention. The other ten women in the continued catheterization group opted for sling lysis ≤6 months after MUS surgery. None of the women in the mobilization group reported SUI at 6 months in contrast to 9 of 20 (45%) in the planned continued catheterization group (p = 0.029). Seven of the nine women experiencing recurrent SUI had undergone sling lysis.
  
  
  CONCLUSIONS
  Patients experiencing EVD after MUS surgery can be informed that UR will resolve in 50% with continued catheterization. Mobilization should be an option for those not comfortable with prolonged catheterization. Early intervention by mobilization may be associated with a lower risk of recurrent SUI, compared to continued catheterization and delayed sling lysis.
authors.affiliation: Division of Urogynecology, Department of Obstetrics & Gynecology, University of Calgary, 4th floor, North Tower, Foothills Hospital, 1403-29 Street NW, Calgary, AB, Canada, T2N 2T9. Erin.brennand@albertahealthservices.ca.
authors.forename: Erin A
authors.initials: EA
authors.lastname: Brennand
authors.affiliation: Department of Obstetrics & Gynecology, University of Calgary, 4th floor, North Tower, Foothills Hospital, 1403-29 Street NW, Calgary, AB, Canada, T2N 2T9.
authors.forename: Selphee
authors.initials: S
authors.lastname: Tang
authors.affiliation: Division of Urogynecology, Department of Obstetrics & Gynecology, University of Calgary, 4th floor, North Tower, Foothills Hospital, 1403-29 Street NW, Calgary, AB, Canada, T2N 2T9.
authors.forename: Colin
authors.initials: C
authors.lastname: Birch
authors.affiliation: Division of Urogynecology, Department of Obstetrics & Gynecology, University of Calgary, 4th floor, North Tower, Foothills Hospital, 1403-29 Street NW, Calgary, AB, Canada, T2N 2T9.
authors.forename: Magali
authors.initials: M
authors.lastname: Robert
authors.affiliation: Division of Urogynecology, Department of Obstetrics & Gynecology, University of Calgary, 4th floor, North Tower, Foothills Hospital, 1403-29 Street NW, Calgary, AB, Canada, T2N 2T9.
authors.forename: Shunaha
authors.initials: S
authors.lastname: Kim-Fine
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D057928:Intermittent Urethral Catheterization; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D012086:Reoperation; D053825:Suburethral Slings / Q000009:adverse effects*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014555:Urination Disorders / Q000209:etiology / Q000628:therapy*
keywords: Midurethral sling; Sling loosening; Sling lysis; Sling mobilization; Urinary retention; Voiding dysfunction