Clinical predictors of obstruction in women with chronic lower urinary tract symptoms following remote urethral sling surgery
James Ross1, Lidia Avvakoumova1, Alaya Yassein2, Conrad Maciejewski1, Humberto Vigil1, Duane R. Hickling1,3.
1Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada; 2Halton Healthcare, Georgetown, ON, Canada; 3The Ottawa Hospital Research Institute, Ottawa, ON, Canada
Introduction: Assessment and management of patients with chronic lower urinary tract symptoms following remote urethral sling surgery is not well-defined. The objective of this study was to review patients with chronic urinary symptoms and a history of urethral sling surgery to determine the incidence and clinical predictors of obstruction.
Methods: A single-center, retrospective review was performed on all patients referred with >6 months of urinary symptoms and a history of urethral sling surgery. All patients underwent history, physical exam, cystoscopy, and urodynamic testing (± fluoroscopy). Obstruction was identified by urodynamics using the Blaivas criteria or fluoroscopy. Clinical findings for patients with and without obstruction were compared. Patients undergoing sling lysis were assessed for postoperative outcomes.
Results: A total 106 patients were included with median age of 61 years (interquartile range [IQR] 19) and median time since sling surgery of five years (IQR 8). Fifty-nine percent (63/106) met the definition for bladder outlet obstruction. Patients with obstruction had significantly higher mean detrusor pressure (PDet) at maximal flow rate (Qmax) (35 vs. 19 cmH2O), lower Qmax (6 vs. 14 mL/s), and higher postvoid residual (PVR) (217 vs. 72 mL) (p<0.05). A tight suburethral band was the only clinical finding significantly associated with obstruction (p=0.003). Time since sling surgery and type of urinary symptoms were not associated with obstruction. Fifty-one (80%) obstructed patients underwent sling lysis, after which 90% reported improvement in voiding symptoms, 41% reported improvement in storage symptoms, and 43% reported recurrent incontinence (median followup 18 months, IQR 20.5). Five patients (5/51, 10%) underwent redo sling procedure.
Conclusions: Obstruction is common in patients presenting with chronic urinary symptoms and a history of sling surgery; however, few clinical predictors exist and urodynamics may be warranted. Patients undergoing sling lysis should be observed for persistent storage symptoms and recurrent incontinence.
