Predicting the Postoperative Voiding Trial

Objective: To determine whether midurethral sling with concomitant pelvic floor surgery increases the rate of postoperative urinary retention compared with sling alone. Methods: A retrospective cohort study was conducted comparing women who underwent midurethral sling placement alone or sling with concomitant pelvic floor surgery from 2010 to 2017 in an academic hospital. Patients with planned prolonged catheterization were excluded. Postoperatively, patients underwent a voiding trial involving retrograde fill of the bladder, removal of Foley catheter, and attempt to spontaneously void. Failure was defined as postoperative urinary retention requiring catheterization at discharge. Descriptive statistics and univariate analyses were used to compare groups. We used backward stepwise multivariable logistic regression to adjust for significant baseline differences with <10% missingness between groups. Results: 336 patients included, 241 underwent sling plus concomitant pelvic floor procedures, and 95 underwent sling alone. 15% (52/336) patients were discharged with catheterization. On univariate analysis, patients with sling placement plus concomitant procedures were more likely to be discharged home with catheterization vs. sling alone (46/241 (19%) vs. 6/95 (6.3%); odds ratio 3.49, 95% confidence interval 1.41–10.37, p = 0.003). The baseline differences between sling-alone and concomitant procedure groups included body mass index, age, parity, preoperative post void residual, preoperative maximum flow rate, and presence of mixed urinary incontinence. There were no differences in sling type, recurrent stress urinary incontinence, or prior urogynecologic surgery between groups. Using backward stepwise elimination, we found no covariates improved the model, so no adjustments were made. Conclusion: Concomitant pelvic floor procedures at the time of sling placement were more likely to be associated with postoperative urinary retention than sling placement alone.