Determinants of voiding after three types of incontinence surgery: A multivariable analysis

Objective: To determine the time to normal voiding in women after various s urgical procedures for genuine stress urinary incontinence (GSUI) or urethr al hypermobility. Methods: One hundred one women had bladder neck suspensions. Suprapubic cat heters were used in 94 women and intermittent self-catheterization in seven to manage urinary retention after surgery. We used a standardized protocol to record days to adequate postoperative voiding. Univariable and multivar iable regression analyses were used to determine clinical, urodynamic, and surgical factors that independently influenced time to adequate postoperati ve voiding. Results: Women met the criteria for adequate voiding a mean of 7.1 days aft er modified open Burch procedures (n = 43), 9.5 days after anterior colporr haphies with suburethral plication (n = 24), and 19.1 days after vaginal wa ll sling procedures (n = 34). The type of bladder neck suspension was indep endently associated with increasing time to void (P = .001). Multivariable regression analysis determined other factors significantly associated with longer time to adequate postoperative voiding: advancing age, previous vagi nal bladder neck suspension, increasing volume at first sensation on bladde r filling, higher postvoid residual urine volume (preoperative), and postop erative cystitis. Detrusor pressure, abdominal straining on pressure now vo iding study, and other concurrent surgeries were not significantly associat ed with postoperative voiding time in this model. Conclusions: Time to adequate voiding after bladder neck suspension was inf luenced by type of surgical procedure, postoperative cystitis, and several demographic and urodynamic factors. This study does not support using press ure now studies to predict women at risk of voiding dysfunction. (C) 2001 b y The American College of Obstetricians and Gynecologists.