Does the MONARC transobturator suburethral sling cause post-operative voiding dysfunction? A prospective study

Area of Science:

• Urogynecology
• Female Pelvic Medicine

Background:

• Urodynamic stress incontinence (USI) significantly impacts women's quality of life.
• Transobturator tape (TOT) procedures are common surgical interventions for USI.

Purpose of the Study:

• To evaluate pre-operative and post-operative voiding parameters in women undergoing MONARC TOT insertion for USI.
• To assess the impact of MONARC TOT on objective and subjective measures of voiding function.

Main Methods:

• Prospective observational study of 83 women with USI.
• Assessment of voiding parameters including maximum flow rate (Qmax), adjusted Qmax (Qmaxadj) using the Liverpool nomogram (LN), and post-void residual (PVR) pre-operatively and at 6-8 weeks post-operatively.

Main Results:

• Adjusted maximum flow rate (Qmaxadj) significantly decreased post-operatively (26 ml/s to 18 ml/s, p<0.05).
• No significant changes were observed in post-void residual (PVR) or the proportion of women with flow rates below the 10th centile on LN.
• Only one patient (1.2%) was diagnosed with voiding dysfunction post-operatively, which was not statistically significant.

Conclusions:

• Insertion of the MONARC TOT leads to a significant reduction in adjusted free flow rates.
• Despite objective changes in flow rates, patient satisfaction remains high, with no statistically significant increase in short-term voiding dysfunction.
• Long-term follow-up is necessary to fully assess the impact on voiding parameters.