NEW ORLEANS, LA USA (UroToday.com) - There is a growing concern for the use of retropubic slings (RPS) in women who void with Valsalva, due to the potential risk of voiding dysfunction. Valsalva voiding (VV) is defined as the increased abdominal pressure observed throughout the voiding phase of urodynamics. During times of increased intra-abdominal pressure (Pabd), the sling’s design decreases urine flow across the urethra during. VV may also affect the continence mechanism of slings. With this knowledge, the authors aim to compare outcomes after retropubic sling placement in women who void with and without Valsalva.
The authors reviewed data from 2011-2013 for RPS treatment of stress urinary incontinence (SUI) from 141 women. They were then separated into 2 arms: 66 non-Valsalva voiders (NV) and 75 VV. Of the VV arm, 58 had appreciable detrusor contraction (non-DU), while 17 had detrusor underactivity (DU), i.e., the maximum detrusor pressure (Pdet) of less than 10 cm H2O and/or detrusor contraction duration of less than 10 seconds. Success was subjectively determined by an absence of SUI with coughing, laughing, or sneezing. The primary outcomes of the study include: subjective success rate, complication rate, and revision rate. The authors secondarily looked at: catheter time, rate of passing initial void trial, CIC requirement, pad usage, and UDI-6 and IIQ-7 validated scoring systems.
For the baseline characteristics, VV and NV were similar with respect to age, race, comorbidity, pad use, and UCI-6 scores. When looking at VV versus NV, VV yielded a higher parity (3.7) than NV (2.9), and VV had a less severe IIQ-7 (9.5, as opposed to 12.6). When looking at preoperative urodynamics, there were no differences in: Max Pdet, Pdet at Qmax, capacity and Valsalva, or abdominal leak-point pressures. Additionally, VV had a detrusor underactivity of 23%, while NV was only 5%, and incomplete emptying was 26% versus 3%, respectively. With respect to the complication rates and revision rates, VV and NV were very similar. Within VV, for DU versus non-DU, complication rate and revision rates were not significantly different. As for the secondary outcomes, VV and NV had similar catheter times, and there were no significant differences between groups in their rate of passing initial void trial or CIC.
They conclude that their results differ to those from previous studies that found patients voiding by Valsalva may have lower success rate, increased risk of retention, and possibly increased risk for sling revision. Some of the limitations of the study include the retrospective nature and a lack of long-term follow-up, along with the use of a single surgeon’s patients. Future studies will include a larger patient population from multiple institutions.
Presented by Blake Anderson at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
University of Chicago, Chicago, IL USA
Reported by Victor Huynh (University of California-Irvine), medical writer for UroToday.com