Predictors of voiding dysfunction following extensive vaginal pelvic reconstructive surgery

Area of Science:

• Urogynecology
• Female Pelvic Medicine and Reconstructive Surgery

Background:

• Postoperative voiding dysfunction is a common complication following vaginal pelvic reconstructive surgery.
• Identifying predictors is crucial for patient counseling and surgical planning.

Purpose of the Study:

• To identify predictors of postoperative voiding dysfunction in women undergoing extensive vaginal pelvic reconstructive surgery.

Main Methods:

• A cohort of 1,425 women with advanced pelvic organ prolapse (POP-Q stage III or IV) were analyzed.
• Data included 72-hour voiding diaries, validated questionnaires, and pre/postoperative urodynamic studies.
• Surgical procedures involved vaginal pelvic reconstructive surgery with or without transvaginal mesh and/or midurethral sling insertion.

Main Results:

• The overall incidence of postoperative voiding dysfunction was 3.5%.
• Concurrent midurethral sling insertion (OR 3.12) increased the risk.
• Diabetes mellitus, preoperative detrusor pressure at maximal flow (Dmax) <10 cm H2O, and postvoid residual volume ≥200 ml were significant risk factors (ORs 3.07, 1.84, 2.15, respectively).

Conclusions:

• Diabetes, concurrent midurethral sling, low preoperative Dmax, and high postvoid residual volume are key risk factors for postoperative voiding dysfunction.
• Preoperative counseling regarding these risks is recommended for patients considering vaginal pelvic reconstructive surgery.