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OBJECTIVE The aim of this study was to determine the risk factors for catheter use and incomplete bladder emptying (IE) more than 1 week after prolapse repairs and slings. METHODS This is a case-control study of women with prolapse repairs and/or sling from June 2011 to April 2016. All underwent standardized postoperative voiding trial before discharge. Controls and cases of IE were identified by codes and chart review; cases were defined as those needing any postoperative catheterization. We excluded patients with preoperative catheter use or postvoid residual (PVR) greater than 150 mL and those needing postoperative catheterization for reasons other than IE. Univariate and multivariate analyses were performed. RESULTS A total of 475 (30.6%) cases and 478 controls were identified from 1552 eligible patients. Any catheter use was associated with higher uroflow PVR (71.2 vs 54.1 mL, P = 0.006), lower uroflow maximum flow (19.4 vs 25.4 mL/s, P < 0.001), and less detrusor overactivity (DO) (22.0% vs 28.7%, P = 0.03). Seventy-seven (5.0%) patients used catheters more than 1 week, and 15 patients (1.5%) required sling revision.Factors on multivariate analysis associated with any catheter use include office PVR [odds ratio (OR), 1.004; 1.00-1.008], uroflow maximum flow (OR, 0.96; 0.94-0.98), sling (OR, 2.40; 1.51-3.81), and anterior repair (OR, 1.81; 1.15-2.85). Factors associated with IE more than 1 week include uroflow maximum flow (OR, 0.90; 0.84-0.95), DO (OR, 0.21; 0.05-0.83), sling (OR, 3.68; 1.32-10.20), and uterosacral suspensions (OR, 3.43; 1.23-9.54). CONCLUSIONS Overall, the incidence of short-term catheter use was 31%, prolonged IE more than 1 week was 5%, and 1.5% required sling revision. Sling placement, lower maximum flow, and higher preoperative PVR, anterior repair, and uterosacral ligament suspension are risk factors for IE, and presence of DO is protective.

Lower urinary tract symptoms are bothersome and significantly impair patient's quality of life. Incomplete bladder emptying affects both men and women, and has shown to increase in incidence with aging. Incomplete bladder emptying is consequent upon an inability of the detrusor muscle to adequately contract to completely empty the bladder, with or without an increased bladder outlet resistance; this can be defined urodynamically as detrusor underactivity (DUA). The symptom complex consequent upon DUA is referred to as underactive bladder (UAB). Although the occurrence of DUA increases with age, and is commonly encountered in clinical practice, it is a largely unrecognized and consequently under researched condition.In this article, we will highlight the importance of DUA. We will review UAB as currently defined, the symptoms of DUA, its epidemiology, and etiopathogenesis, risk factors for developing DUA, and methods of diagnosis with an up-to-date review of the contemporary literature.DUA and its associated symptoms and signs are still poorly recognized entities. Difficulty and confusion arise in properly diagnosing DUA, as at present it can only be accurately defined on the basis of pressure flow urodynamics. Current attention is focused on validating a satisfactory definition for the syndrome complex of UAB.

INTRODUCTION AND OBJECTIVES:Urinary retention is a significant adverse event after surgery which predisposes patients to increased hospital stay and avoidable returns to the Emergency Department. T...

Underactive bladder (UAB) is characterized by prolonged voiding, hesitancy, and slow and/or intermittent stream with or without a sensation of incomplete bladder emptying. The overlap of UAB lower urinary tract symptoms with those of overactive bladder or bladder outlet obstruction, as well as its multifactorial etiology, make UAB study, as well as its diagnosis and management, a very arduous and challenging task. Therefore, despite its incidence and significant impact in the quality of life of both men and women, UAB remains a poorly understood urologic condition with insufficient and ineffective treatment options available. In this review, we will focus on the etiology theories that have been proposed and the animal models available to test those theories.

Menkes’ syndrome, a rare sex-linked disorder of copper metabolism, has been found to be associated with a high incidence of urologic abnormalities. Bladder diverticula were present in 3 of the 4 patients reviewed. Management of incomplete bladder emptying and consequent urinary tract infection is discussed.

In most recent series of artificial sphincter implantations there has been a reduction in mechanical and surgical complications, with continence rates approaching 90 per cent. Despite initially excellent results in 47 children, with increasing durations of followup we noted a transient hydronephrosis related to incomplete bladder emptying in 5 and a persistent physiological alteration of detrusor dynamics consisting of a rigid, noncompliant bladder in 7. Preoperatively, all patients had had in-depth radiological studies and most had a urodynamic evaluation, and were considered to be excellent candidates. The etiology of these alterations is not understood at this time. Bladder and even upper tract deterioration can occur without the appearance of urinary leakage. Therefore, children with an artificial sphincter must be monitored indefinitely with semiannual assessment of the upper tracts and periodic urodynamic evaluation.