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Management of obstructive voiding dysfunction after incontinence surgery: lessons learned

      Ameta-analysis conducted by the American Urological Association Female Stress Urinary Incontinence Clinical Guidelines Panel estimated a 67%, 84%, and 83% cure rate at 48 months and longer for transvaginal suspensions, retropubic suspensions, and slings, respectively.
      • Leach G.E.
      • Dmochowski R.R.
      • Appell R.A.
      • et al.
      Female Stress Urinary Incontinence Clinical Guidelines Panel summary report on surgical management of female stress urinary incontinence.
      Although these surgical options have clearly been effective in curing stress urinary incontinence (SUI), postoperative voiding dysfunction remains a major factor affecting outcomes. Voiding dysfunction can manifest as storage or voiding symptoms. Storage symptoms, such as frequency, urgency, nocturia, and urge incontinence, may occur de novo, persist, or worsen from the preoperative status. Voiding symptoms include a delay in initiating a stream, voiding with abdominal straining or changes in position, incomplete emptying, and urinary retention.
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      References

        • Leach G.E.
        • Dmochowski R.R.
        • Appell R.A.
        • et al.
        Female Stress Urinary Incontinence Clinical Guidelines Panel summary report on surgical management of female stress urinary incontinence.
        J Urol. 1997; 158: 875-880
        • Wang A.C.
        Burch colposuspension vs. Stamey bladder neck suspension.
        J Reprod Med. 1996; 41: 529-533
        • Juma S.
        • Sdrales L.
        Etiology of urinary retention after bladder neck suspension.
        J Urol. 1993; 149 (abstract): 400A
        • Spencer J.R.
        • O'Conor Jr, V.J.
        • Schaeffer A.J.
        Comparison of endoscopic suspension of the vesical neck with suprapubic vesicourethropexy for treatment of stress urinary incontinence.
        J Urol. 1987; 137: 411-415
        • Rost A.
        • Fiedler U.
        • Fester C.
        Comparative analysis of the results of suspension-urethroplasty according to Marshall-Marchetti-Krantz and of urethrovesicopexy with adhesive.
        Urol Int. 1979; 34: 167-175
        • Mundy A.R.
        A trial comparing the Stamey bladder neck suspension with colposuspension for the treatment of stress incontinence.
        Br J Urol. 1983; 55: 687-690
        • Cardozo L.D.
        • Stanton S.L.
        • Williams J.E.
        Detrusor instability following surgery for genuine stress incontinence.
        Br J Urol. 1979; 51: 204-207
        • Carr L.K.
        • Webster G.D.
        Voiding dysfunction following incontinence surgery.
        J Urol. 1997; 157: 821-823
        • Morgan T.O.
        • Westney O.L.
        • McGuire E.J.
        Pubovaginal sling.
        J Urol. 2000; 163: 1645-1648
        • Chaiken D.C.
        • Rosenthal J.
        • Blaivas J.G.
        Pubovaginal fascial sling for all types of stress urinary incontinence.
        J Urol. 1998; 160: 1312-1316
        • Klutke C.
        • Siegel S.
        • Carlin B.
        • et al.
        Urinary retention after tension-free vaginal tape procedure.
        Urology. 2001; 58: 697-701
        • Pope A.J.
        • Shaw P.J.R.
        • Coptcoat M.J.
        • et al.
        Changes in bladder function following a surgical alteration in outflow resistance.
        Neurourol Urodyn. 1990; 9: 503-508
        • Bump R.C.
        • Hurt W.G.
        • Elser D.M.
        • et al.
        Understanding lower urinary tract function in women soon after bladder neck surgery.
        Neurourol Urodyn. 1999; 18: 629-637
        • Harrison S.C.
        • Hunnam G.R.
        • Farman P.
        • et al.
        Bladder instability and denervation in patients with bladder outflow obstruction.
        Br J Urol. 1987; 60: 519-522
        • Speakman M.J.
        • Brading A.F.
        • Guilpin C.J.
        • et al.
        Bladder outflow obstruction.
        J Urol. 1987; 138: 1461-1466
        • Cardozo L.D.
        • Stanton S.L.
        • Williams J.E.
        Detrusor instability following surgery for genuine stress incontinence.
        Br J Urol. 1979; 51: 204-207
        • Calvert R.C.
        • Thompson C.S.
        • Khan M.A.
        • et al.
        Alterations in cholinergic and purinergic signaling in a model of the obstructed bladder.
        J Urol. 2001; 166: 1530-1533
        • Iglesia C.B.
        • Shott S.
        • Fenner D.E.
        • et al.
        Effect of preoperative voiding mechanism on success rate of autologous rectus fascia suburethral sling procedure.
        Obstet Gynecol. 1998; 91: 577-581
        • Weinberger M.W.
        • Ostergard D.R.
        Postoperative catheterization, urinary retention, and permanent voiding dysfunction after polytetrafluoroethylene suburethral sling placement.
        Obstet Gynecol. 1996; 87: 50-54
        • Bhatia N.N.
        • Bergman A.
        Urodynamic predictability of voiding following incontinence surgery.
        Obstet Gynecol. 1984; 63: 85-91
        • Sze E.H.
        • Miklos J.R.
        • Karram M.M.
        Voiding after Burch colposuspension and effects of concomitant pelvic surgery.
        Obstet Gynecol. 1996; 88: 564-567
        • McLennan M.T.
        • Melick C.F.
        • Bent A.E.
        Clinical and urodynamic predictors of delayed voiding after fascia lata suburethral sling.
        Obstet Gynecol. 1998; 92: 608-612
      1. Petrou SP, and Nitti VW: Urethrolysis. AUA Update Series, Volume XX, Lesson 22: 169–176, 2001

        • McGuire E.J.
        • Letson W.
        • Wang S.
        Transvaginal urethrolysis after obstructive urethral suspension procedures.
        J Urol. 1989; 142: 1037-1039
        • Nitti V.W.
        • Raz S.
        Obstruction following anti-incontinence procedures.
        J Urol. 1994; 152: 93-98
        • Cross C.A.
        • Cespedes R.D.
        • English S.F.
        • et al.
        Transvaginal urethrolysis for urethral obstruction after anti-incontinence surgery.
        J Urol. 1998; 159: 1199-1201
        • Petrou S.P.
        • Brown J.A.
        • Blaivas J.G.
        Suprameatal transvaginal urethrolysis.
        J Urol. 1999; 161: 1268-1271
        • Leach G.E.
        • Raz S.
        Modified Pereyra bladder neck suspension after previously failed anti-incontinence surgery.
        Urology. 1984; 23: 359-362
        • Petrou S.P.
        • Jones J.
        • Parra R.O.
        Martius flap harvest site.
        J Urol. 2002; 167: 2098-2099
        • Webster G.D.
        • Kreder K.J.
        Voiding dysfunction following cystourethropexy.
        J Urol. 1990; 144: 670-673
        • McLennan M.T.
        • Bent A.E.
        Sling incision with associated vaginal wall interposition for obstructed voiding secondary to suburethral sling procedure.
        Int Urogynecol J. 1997; 8: 168-172
        • Ghoniem G.M.
        • Elgamasy A.N.
        Simplified surgical approach to bladder outlet obstruction following pubovaginal sling.
        J Urol. 1995; 154: 181-183
        • Kusuda L.
        Simple release of pubovaginal sling.
        Urology. 2001; 57: 358-359
        • Nitti V.W.
        • Carlson K.V.
        • Blaivas J.G.
        • et al.
        Early results of pubovaginal sling lysis by midline sling incision.
        Urology. 2002; 59: 47-51
        • Kinn A.C.
        Tension-free vaginal tape evaluated using patient self-reports and urodynamic testing—a two-year follow-up.
        Scand J Urol Nephrol. 2001; 35: 484-490
        • Sweat S.D.
        • Itano N.B.
        • Clemens J.Q.
        • et al.
        Polypropylene mesh tape for stress urinary incontinence.
        J Urol. 2002; 168: 144-146
        • Romanzi L.J.
        • Blaivas J.G.
        Protracted urinary retention necessitating urethrolysis following tension-free vaginal tape surgery.
        J Urol. 2000; 164: 2022-2023
        • Brubaker L.
        Suburethral sling release.
        Obstet Gynecol. 1995; 86: 686-688
        • Petrou S.P.
        • Young P.R.
        Rate of recurrent stress urinary incontinence after retropubic urethrolysis.
        J Urol. 2002; 167: 613-615
        • Amundsen C.L.
        • Guralnick M.L.
        • Webster G.D.
        Variations in strategy for the treatment of urethral obstruction after a pubovaginal sling procedure.
        J Urol. 2000; 164: 434-437
        • Goldman H.B.
        • Rackley R.R.
        • Appell R.A.
        The efficacy of urethrolysis without resuspension for iatrogenic urethral obstruction.
        J Urol. 1999; 161: 196-199
        • Austin P.
        • Spyropoulos E.
        • Lotenfoe R.
        • et al.
        Urethral obstruction after anti-incontinence surgery in women.
        Urology. 1996; 47: 890-894
        • Dmochowski R.R.
        • Leach G.E.
        • Zimmern P.E.
        • et al.
        Urethrolysis to relieve outlet obstruction after prior incontinence surgery.
        J Urol. 1994; 151 (abstract): 420A
        • Foster H.E.
        • McGuire E.J.
        Management of urethral obstruction with transvaginal urethrolysis.
        J Urol. 1993; 150: 1448-1451
        • Zimmern P.E.
        • Hadley H.R.
        • Leach G.E.
        • et al.
        Female urethral obstruction after Marshall-Marchetti-Krantz operation.
        J Urol. 1987; 138: 517-520
        • Moloney P.J.
        • Fenster H.N.
        Bladder-neck incision for relief of obstruction after anti-incontinence surgery.
        Int Urogynecol J. 1993; 4: 68-69
        • Game X.
        • Malavaud B.
        • Mouzin M.
        • et al.
        Treatment of chronic urinary retention after surgical treatment of urinary incontinence with bladder neck transurethral resection.
        Prog Urol. 2000; 10: 629-633
        • Smith C.P.
        • O'Leary M.
        • Erickson J.
        • et al.
        Botulinum toxin urethral sphincter injection resolves urinary retention after pubovaginal sling operation.
        Int Urogynecol J Pelvic Floor Dysfunct. 2002; 13: 185-186
        • Scarpero H.M.
        • Dmochowski R.R.
        • Nitti V.W.
        Repeat urethrolysis after failed urethrolysis for iatrogenic obstruction.
        J Urol. 2003; 169: 1013-1016