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Active Compared With Passive Voiding Trials After Midurethral Sling Surgery: A Systematic Review.

Siri Drangsholt1, Cassidy Lleras, Rebecca Kindler

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Passive voiding trials are more effective than active trials for women undergoing midurethral sling surgery for stress urinary incontinence (SUI), showing higher success rates and fewer catheter discharges. Complication rates were similar, but passive trials had fewer sling revisions.

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Area of Science:

  • Urology
  • Female Pelvic Medicine and Reconstructive Surgery

Background:

  • Stress urinary incontinence (SUI) is a common condition affecting women.
  • Midurethral sling procedures are a standard surgical treatment for SUI.
  • Postoperative voiding dysfunction is a potential complication following sling surgery.

Approach:

  • A systematic review and meta-analysis was conducted using data from MEDLINE, EMBASE, and ClinicalTrials.gov.
  • Studies comparing active versus passive voiding trials in women who underwent midurethral sling surgery were included.
  • Primary outcomes included the rate of passing a voiding trial and the rate of discharge with a catheter.

Key Points:

  • Passive voiding trials demonstrated a higher success rate (89.0%) compared to active trials (81.0%) in women undergoing midurethral sling surgery.
  • Discharge with a catheter was significantly lower in the passive voiding trial group (7.0%) versus the active group (19.0%).
  • Rates of delayed postoperative urinary retention were low and similar between groups, but sling revisions were lower in the active trial group.

Conclusions:

  • Passive voiding trials are associated with higher rates of successful voiding and lower rates of catheter-dependent discharge post-midurethral sling surgery.
  • While most complications were similar, passive voiding trials showed a trend towards higher sling revisions.
  • The findings suggest passive voiding trials may be a more efficient method for assessing bladder function after SUI surgery.