Abstract
The objective of the study was to determine preoperative factors (symptoms, history, clinical findings, urodynamic factors or operative findings) associated with voiding difficulties following colposuspension. This retrospective review was undertaken at a urogynaecological clinic in a large district general hospital. Fifty-one patients who had undergone colposuspension for genuine stress incontinence were included. Voiding difficulty was the main outcome measure. This was assessed by time of spontaneous voiding and time of catheter removal. Age was associated with postoperative voiding difficulty when this was assessed by time of catheter removal (P<0.02) and by time of spontaneous voiding (P<0.05). A low preoperative maximum voiding pressure was associated with delayed spontaneous voiding (P<0.05) but not with prolonged catheterization. It was concluded that older patients were at greater risk of voiding difficulty following colposuspension and that HRT did not prevent this complication.
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EDITORIAL COMMENT: Factors which definitively predict those patients who will be subjected to prolonged catheterization after incontinence surgery are currently unknown. Age is known to be a factor, as is confirmed by this study, and previously low voiding pressure was also determined to be such a factor [11] and also has been confirmed here. A big factor which has not been addressed in the literature is the effect of the degree of elevation of the vesical neck by the surgical procedure, and its effects on voiding difficulty. It would seem reasonable to assume that a patient with a higher vesical neck and a Q-tip test approximating −30° from the horizontal would void less freely and later than one with a Q-tip test of +10° from the horizontal. It has, however, been this editor's clinical experience that there is no relationship of this ‘anatomy factor’ to ultimate time of catheter removal. Studies would provide a great deal of information if the degree of elevation of the vesical neck was controlled and accounted for in the analysis of data.
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Kremer, C.C., Freeman, R.M. Which patients are at risk of voiding difficulty immediately after colposuspension?. Int Urogynecol J 6, 257–261 (1995). https://doi.org/10.1007/BF01901519
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DOI: https://doi.org/10.1007/BF01901519