Bladder Outlet Obstruction After Incontinence Surgery
- 117 Downloads
Stress urinary incontinence (SUI) is said to effect up to 80 % of all women who complain of some type of urinary leakage. As education about the diagnosis and treatment of SUI becomes more widespread, there is a need for understanding the efficacy and potential complications of the therapies used to treat this condition. It is widely accepted that the gold standard for treatment of SUI is mid-urethral sling (MUS). One significant complication of the MUS procedure is subsequent bladder outlet obstruction (BOO). We review the incidence and etiology of BOO following MUS and hope this document can be used as a guide for identifying patients who may be affected by postsurgical BOO. Additionally, we discuss modalities for achieving a timely and accurate diagnosis and highlight recent evidence regarding the various applications of urodynamic studies, when concerned for BOO. Lastly, various managements of this complication are discussed. This chapter serves as a comprehensive overview of BOO after incontinence procedures, highlighting the recent research contributions, which have enhanced our understanding of this potential complication when treating SUI.
KeywordsBladder outlet obstruction Anti-incontinence procedure Mid-urethral sling Stress urinary incontinence Sling complications
Compliance with Ethics Standards
Conflict of Interest
Drs, Brucker and Malacarne declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.••Ford AA RL, Cody JD, Ogah J. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2015. This is the newest Cochrane Review of the literature assessing the clinical effects of mid-urethral sling (MUS) operations for the treatment of stress urinary incontinence (SUI), urodynamic stress incontinence (USI) or mixed urinary incontinence (MUI) in women. Google Scholar
- 3.Milsom IAD, Lapitan MC, Nelson R, Sillen U, Thom DH. Epidemiology of urinary (UI) and faecal (FI) incontinence and pelvic organ prolapse (POP) 2009. In: Abrams P, Cardozo L, Khoury S, Wein AJ, editors. Incontinence: 4th international consultation on incontinence. Paris: Health Publication Ltd; 2009. p. 35–112.Google Scholar
- 4.Ogah J CJ, Rogerson L. Minimally invasive synthetic suburethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2009.Google Scholar
- 5.•Nager C, Tulikangas P, Miller D, Rovner E, Goldman H. Position statement on mesh midurethral slings for stress urinary incontinence. Female Pelvic Med Reconstr Surg. 2014;20:123–5. This is the AUGS and SUFU joint position statement reiterating the safety and efficacy of MUS as the “gold standard” for treatment of SUI today.CrossRefPubMedGoogle Scholar
- 20.••Jonsson Funk M, Siddiqui NY, Pate V, Amundsen CL, Wu JM. Sling revision/removal for mesh erosion and urinary retention: long-term risk and predictors. Am J Obstet Gynecol. 2013;208:73 e1–7. This is the largest population based cohort study with the longest follow-up analysis describe looking at women who had MUS procedures. Over 188,000 women were evaluated over a 9-year study period in order to assess long-term risks of sling revision/removal and also to identify predictors of this outcome.CrossRefGoogle Scholar
- 23.Sarnelli G, D’Urso L, Muto G. Tension-free vaginal tape (TVT) for the treatment of female stress urinary incontinence (SUI): evaluating perineal ultrasound (PU) findings in postoperative voiding obstructive complaints. Arch Ital Urol, Androl: Organo Ufficiale [di] Soc Ital Ecografia Urol Nefrol / Associazione Ric Urol. 2008;80:92–4.Google Scholar
- 33.Nitti VW, Fleischmann N. Vaginal approach to postsurgical bladder outlet obstruction vaginal surgery for incontinence and prolapse. 2006.Google Scholar