This study aims to objectively and subjectively assess the frequency of voiding dysfunction following anti-incontinence surgeries, including tension-free vaginal tape (TVT), transobturator tape (TOT), Burch colposuspension, and fascial sling procedures in an 8 years cohort to explore the associated risk factors.

This was a retrospective cohort study involving women who underwent anti-urinary incontinence surgery between December 2014 and December 2021 at Imam Khomeini Hospital, Tehran. Data collection included demographic, medical, surgical, and urodynamic data from the hospital’s pelvic surgery registration software. Voiding dysfunction was assessed preoperatively and postoperatively via post-void residual (PVR) volume and urinary dysfunction symptoms. Acute voiding dysfunction was defined by elevated postoperative PVR, while delayed dysfunction was identified through follow-up PVR or reported urinary symptoms. Patient satisfaction and subjective symptoms were assessed using the Urogenital Distress Inventory (UDI-6) and the Patient Global Impression of Improvement (PGI-I) questionnaire. Statistical analyses were performed using SPSS software, with a significance level set at P<0.05.

The study found that the mean PVR increased post-surgery across all groups, with 6.8% of participants showing a PVR >100ml the day after surgery. A significant association was observed between preoperative PVR and postoperative PVR >100ml (P=0.001). Additionally, 14.3% of participants experienced new voiding dysfunction after surgery, with the highest incidence observed in the fascial sling group and the lowest in the TOT group. A significant relationship was noted between preoperative PVR and new postoperative voiding dysfunction (P=0.042). Satisfaction levels, assessed using UDI-6 and PGI-I, were high across all groups.

This study demonstrates that preoperative PVR is a predictor of both objective and subjective urinary dysfunction following incontinence surgery. Furthermore, fascial sling surgery is associated with a higher incidence of subjective voiding dysfunction and urinary urgency postoperatively compared to other procedures.

In Conclusion this study highlights the variable incidence of postoperative voiding dysfunction following anti-incontinence surgery, with preoperative PVR emerging as a key predictor of postoperative retention. While most cases of voiding dysfunction resolve spontaneously, certain surgical approaches, particularly the fascial sling, pose a higher risk. These findings emphasize the need for careful preoperative evaluation, vigilant postoperative monitoring, and patient education to optimize surgical outcomes and minimize voiding complications. Understanding the factors that contribute to postoperative voiding dysfunction is critical for improving surgical outcomes and patient quality of life. Our study adds to the existing body of knowledge by demonstrating that while voiding dysfunction is a concern following anti-incontinence procedures, it does not significantly impact overall patient satisfaction. This suggests that despite temporary voiding difficulties, most patients experience meaningful symptom relief and improved urinary function postoperatively. Future research should further investigate modifiable risk factors for voiding dysfunction and explore targeted interventions to minimize this complication. Additionally, developing standardized postoperative voiding assessment protocols may help identify high-risk patients early and improve long-term surgical outcomes.