(Poster 50) Bothersome Voiding Symptoms After Mid-Urethral Sling and Bulking Procedures

Objectives:

Introduction: Mid-urethral sling and bulking procedures are commonly performed surgical interventions for stress urinary incontinence (SUI). While these procedures are effective in reducing urinary leakage, concerns regarding bothersome voiding symptoms post-procedurally have been raised. There has been limited information on this important aspect of incontinence care. Understanding the impact of these procedures on voiding function is crucial for optimizing patient outcomes and decision-making.

Objective: To determine and compare the incidence and degree of bothersome voiding symptoms before and after mid-urethral sling and bulking procedures for SUI.

Methods: A cross-sectional study was conducted at a single institution following patients who completed a mid-urethral sling or a urethral bulking procedure for SUI between July 1, 2024 and February 28, 2025. Patients who consented for the study received a phone call 4-8 weeks after their procedure to complete a 3-part subjective survey. Electronic medical records of patients who consented for use of personal health information for research were reviewed for overt urinary retention post-procedurally, defined as a post-void residual of at least 100 cc.

Results: To date, 48 patients in the sling group and 47 patients in the bulking group completed the survey. Compared to before the procedure, 15 (31%) of the sling group and 11 (23%) of the bulking group reported a weaker stream after the procedure. When asked about the time spent urinating, 24 (50%) of the sling group and 24 (51%) of the bulking group reported longer time on the toilet. Eight (17%) and 11 (23%) of the sling group and bulking group reported that these changes in voiding function were bothersome, respectively. Twenty-five (52%) of the sling group and 34 (72%) of the bulking group consented for use of personal health information for research. Of these patients, only 1 (4%) of the sling group and 1 (3%) of the bulking group showed new urinary retention post-procedurally. Demographics between the sling and bulking groups were not statistically different.

Conclusions: Preliminary data indicate that while overt postoperative urinary retention is uncommon, a substantial proportion of patients report bothersome voiding symptoms following surgical intervention for SUI. These findings highlight a clinically relevant issue that warrants further investigation and anticipate will contribute to optimizing patient selection and counseling regarding surgical interventions for urinary incontinence, ultimately improving patient outcomes and quality of life.

Figure 1: Percent of Responses to Survey Questions. Q1: Is the force of stream stronger (white), same (gray), or weaker (black)? Q2: Is the time spent urinating shorter (white), same (gray), or longer (black)? Q3: How much does the change in urine stream bother you? Not at all (green), Somewhat (yellow), Very Much (red).