A randomized controlled trial comparing two voiding trials after midurethral sling with or without colporrhaphy

Area of Science:

• Urogynecology
• Surgical Innovation
• Clinical Trials

Background:

• Midurethral sling (MUS) surgery is a common treatment for female stress urinary incontinence.
• Postoperative voiding dysfunction (VD) and urinary tract infections (UTIs) are common complications following MUS procedures.
• Standard voiding trials (SVT) are used to assess bladder function after surgery, but alternative methods like the force of the stream (FOS) voiding trial are being explored.

Purpose of the Study:

• To compare the efficacy and safety of the force of the stream (FOS) voiding trial against the standard voiding trial (SVT) in patients undergoing outpatient midurethral sling (MUS) surgery.
• To determine if the FOS method is non-inferior to the SVT in terms of unexpected postoperative visits for voiding dysfunction or urinary tract infections.

Main Methods:

• A randomized controlled non-inferiority trial involving 102 patients scheduled for MUS, with or without colporrhaphy.
• Patients were randomized to either the FOS or SVT group.
• The primary outcome was the number of unexpected postoperative visits (UPOVs) for VD or UTI, with VD defined as urinary retention or post-void residual (PVR) > 200 cc.

Main Results:

• No evidence of non-inferiority was found when comparing FOS to SVT for total UPOVs related to postoperative VD or UTIs.
• Immediate postoperative catheterization rates were similar between the FOS (8.2%) and SVT (9.4%) groups.
• Recovery time was significantly shorter for the FOS group compared to the SVT group (p=0.0002).

Conclusions:

• The force of the stream (FOS) voiding trial is a viable alternative to the standard voiding trial (SVT) after midurethral sling surgery.
• Further research with larger sample sizes is warranted to fully assess the FOS method's utility in patients undergoing prolapse surgery with or without MUS.