E-Posters-Postoperative Retropubic Hematomas and Association with Voiding Dysfunction

Postoperative Retropubic Hematomas and Association with Voiding Dysfunction - Emily Wu, MD

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The prevalence of postoperative voiding dysfunction, such as urinary urgency and frequency, after retropubic mid-urethral sling procedures for stress urinary incontinence (SUI) ranges from 1.5-18%. The underlying cause of these symptoms is not well understood, but it is hypothesized that they may be associated with postoperative retropubic hematomas that occur after the surgery.<br /><br />The objective of this study was to measure the incidence of postoperative retropubic hematomas within six weeks of the sling placement, as well as the incidence of de novo voiding dysfunction within the same period. The study also aimed to determine the correlation between voiding dysfunction and the presence of a retropubic hematoma.<br /><br />The study was conducted as a single-site prospective cohort study at two medical centers in Texas. Subjects were recruited if they were scheduled for a retropubic mid-urethral sling procedure, with or without concurrent pelvic surgery. Transabdominal ultrasound was performed before surgery, immediately after surgery, and at the routine six-week postoperative appointment to evaluate for the presence of a retropubic hematoma. Validated questionnaires were administered before surgery and at the six-week visit to assess voiding dysfunction symptoms.<br /><br />The results showed that the overall incidence of de novo voiding dysfunction at the six-week postoperative visit was low at 9%. Most subjects with voiding dysfunction did not have an associated postoperative retropubic hematoma. Of those who did have a hematoma, 5.9% experienced voiding dysfunction. The incidence of early-onset retropubic hematomas was 18%, but they resolved in all subjects by the six-week visit.<br /><br />Overall, the study suggests that while postoperative retropubic hematomas may be associated with voiding dysfunction, they are not a common cause. The results also highlight the importance of monitoring hemoglobin levels postoperatively, as they were significantly associated with early-onset hematomas.<br /><br />This study provides valuable insights into the association between postoperative retropubic hematomas and voiding dysfunction after retropubic mid-urethral sling procedures for SUI. Further research is needed to better understand the pathophysiology of voiding dysfunction after these procedures.

Keywords

postoperative voiding dysfunction

retropubic mid-urethral sling procedures

stress urinary incontinence

retropubic hematomas

incidence

de novo voiding dysfunction

correlation

retropubic hematoma

prospective cohort study

pathophysiology