Login to Access Video or Poster Abstract: MP46-16
Sources of Funding: None

Introduction

Post-operative urinary retention (POUR) has been reported in 3-21% of patients undergoing a male transobturator sling (TOS) for post-prostatectomy urinary incontinence (PPUI). Our objective was to examine the natural history of POUR in men undergoing TOS, and review the treatment options and resolution rates to propose an algorithm for management.

Methods

We reviewed men undergoing a TOS at our institution from 2006 to 2012. Demographic data, post-operative complications and outcomes were extracted by chart review. Post-operative TOS success was defined as the use of 0 or 1 security pads/day, negative stress test on exam or pad weight less than 8 g/day. POUR was defined as patient reported inability to void requiring urological intervention. T-test, fisher&[prime]s exact test, cox regression model and Kaplan-Meier survival analysis were performed.

Results

290 men with PPSUI that underwent a TOS were identified. POUR was reported in 11.7% (34/290). 33 of these 34 patients had a radical prostatectomy and 1 had a radical cystoprostatectomy with an orthotopic neobladder. POUR was associated with a lower average BMI (25± 2 versus 28± 3, p<0.01). Age, diabetes, pelvic radiation, a prior or concurrent bladder neck contracture had no correlation with POUR. We identified no urodynamic parameters that could distinguish patients that develop POUR during preoperative evaluation._x000D_ _x000D_ 67.6% (23/34) patients were taught and performed temporary clean intermittent catheterization (CIC), 29% (10/34) had a temporary indwelling foley placed. All patients resolved spontaneously with 85% (29/33) lasting 1-7 days and 12% (4/33) for 7-30 days. Figure 1 shows survival estimates of TOS failure in men who experienced short-term POUR versus those who did not (p=0.04). Those with POUR had better long term outcomes with a hazard ratio of 0.47 (95%CI 0.2- 1.0). None had permanent retention nor required surgical intervention such a sling release._x000D_

Conclusions

We feel that this information is valuable in that all cases resolved spontaneously thus allowing us to avoid surgical intervention in these cases. We propose the following algorithm outlined in Figure 2 for the management of POUR.

Funding

None