Skip to main content

Advertisement

Log in

Evaluation and management of urinary retention after a suburethral sling procedure in women

  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Suburethral slings have become the most commonly offered surgical procedure for the correction of stress urinary incontinence in women. Overcorrection of urethral angle or exaggerated applied tension may lead to urethral obstruction, causing complete urinary retention or obstructive voiding symptoms. Acute urinary retention usually indicates immediate surgical intervention. Conversely, obstructive voiding symptoms after a sling procedure require a more thorough evaluation to plan the most appropriate therapy. Different operative procedures ranging from urethrolysis to midline sling incision have been described with high success rates and a small risk of recurrent stress urinary incontinence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Hunskaar S, Burgio K, Clark K, et al.: Epidemiology of urinary and faecal incontinence and pelvic organ prolapse. In Incontinence Volume I: Basics and Evaluation. Edited by Abrams P, Cardozo LD, Khoury S, Wein A. Plymouth, United Kingdom: Health Publication Ltd; 2005:265–266.

    Google Scholar 

  2. Ulmsten U, Henriksson L, Johnson P, Varhos G: An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 1996, 7:81–86.

    Article  PubMed  CAS  Google Scholar 

  3. FitzGerald MP, Brubaker L: The etiology of urinary retention after surgery for genuine stress incontinence. Neurourol Urodyn 2001, 20:13–21.

    Article  PubMed  CAS  Google Scholar 

  4. Chan PT, Fournier C, Corcos J: Short-term complications of pubovaginal sling procedure for genuine stress incontinence in women. Urology 2000, 55:207–211.

    Article  PubMed  CAS  Google Scholar 

  5. Weinberger MW, Ostergard DR: Postoperative catheterization, urinary retention, and permanent voiding dysfunction after polytetrafluoroethylene suburethral sling placement. Obstet Gynecol 1996, 87:50–54.

    Article  PubMed  CAS  Google Scholar 

  6. Morey AF, Medendorp AR, Noller MW, et al.: Transobturator versus transabdominal mid urethral slings: a multi-institutional comparison of obstructive voiding complications. J Urol 2006, 175:1014–1017.

    Article  PubMed  Google Scholar 

  7. Nguyen JK: Diagnosis and treatment of voiding dysfunction caused by urethral obstruction after anti-incontinence surgery. Obstet Gynecol Surv 2002, 57:468–475.

    Article  PubMed  Google Scholar 

  8. Minassian VA, Al-Badr A, Drutz HP, Lovatsis D: Tension-free vaginal tape, Burch, and slings: are there predictors for early postoperative voiding dysfunction? Int Urogynecol J Pelvic Floor Dysfunct 2004, 15:183–187.

    Article  PubMed  Google Scholar 

  9. Miller EA, Amundsen CL, Toh KL, et al.: Preoperative urodynamic evaluation may predict voiding dysfunction in women undergoing pubovaginal sling. J Urol 2003, 169:2234–2237.

    Article  PubMed  Google Scholar 

  10. Shukla A, Paul SK, Nishtar A, Bibby J: Factors predictive of voiding problems following insertion of tension-free vaginal tape. Int J Gynaecol Obstet 2007, 96:122–126.

    Article  PubMed  CAS  Google Scholar 

  11. Vervest HA, Bisseling TM, Heintz AP, Schraffordt Koops SE: The prevalence of voiding difficulty after TVT, its impact on quality of life, and related risk factors. Int Urogynecol J Pelvic Floor Dysfunct 2007, 18:173–182.

    PubMed  Google Scholar 

  12. Marinkovic S: Adjusting bladder neck sling length to maximise same-day voiding. BJOG 2006, 113:1092–1095.

    Article  PubMed  Google Scholar 

  13. Rovner ES, Ginsberg DA, Raz S: A method for intraoperative adjustment of sling tension: prevention of outlet obstruction during vaginal wall sling. Urology 1997, 50:273–276.

    Article  PubMed  CAS  Google Scholar 

  14. Choe JM: Preventing urethral obstruction using the 6-point fixation and weight-adjusted spacing nomogram during sling surgery. Int Urogynecol J Pelvic Floor Dysfunct 2001, 12:122–128.

    Article  PubMed  CAS  Google Scholar 

  15. Pfisterer MH, Griffiths DJ, Rosenberg L, et al.: Parameters of bladder function in pre-, peri-and postmenopausal continent women without detrusor overactivity. Neurourol Urodyn 2007, 26:356–361.

    Article  PubMed  Google Scholar 

  16. Unsal A, Cimentepe E: Voiding position does not affect uroflowmetric parameters and post-void residual urine volume in healthy volunteers. Scand J Urol Nephrol 2004, 38:469–471.

    Article  PubMed  Google Scholar 

  17. Suebnukanwattana T, Lohsiriwat S, Chaikomin R, et al.: Uroflowmetry in normal Thai subjects. J Med Assoc Thai 2003, 86:353–360.

    PubMed  Google Scholar 

  18. Al-Shahrani M, Lovatsis D: Do subjective symptoms of obstructive voiding correlate with post-void residual urine volume in women? Int Urogynecol J Pelvic Floor Dysfunct 2005, 16:12–14.

    Article  PubMed  Google Scholar 

  19. Blaivas JG, Groutz A: Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn 2000, 19:553–564.

    Article  PubMed  CAS  Google Scholar 

  20. Massolt ET, Groen J, Vierhout ME: Application of the Blaivas-Groutz bladder outlet obstruction nomogram in women with urinary incontinence. Neurourol Urodyn 2005, 24:237–242.

    Article  PubMed  Google Scholar 

  21. Defreitas GA, Zimmern PE, Lemack GE, Shariat SF: Refining diagnosis of anatomic female bladder outlet obstruction: comparison of pressure-flow study parameters in clinically obstructed women with those of normal controls. Urology 2004, 64:675–679.

    Article  PubMed  Google Scholar 

  22. Austin P, Spyropoulos E, Lotenfoe R, et al.: Urethral obstruction after anti-incontinence surgery in women: evaluation, methodology, and surgical results. Urology 1996, 47:890–894.

    Article  PubMed  CAS  Google Scholar 

  23. Nitti VW, Tu LM, Gitlin J: Diagnosing bladder outlet obstruction in women. J Urol 1999, 161:1535–1540.

    Article  PubMed  CAS  Google Scholar 

  24. Hammad FT, Kennedy-Smith A, Robinson RG: Erosions and urinary retention following polypropylene synthetic sling: Australasian survey. Eur Urol 2005, 47:641–646.

    Article  PubMed  CAS  Google Scholar 

  25. Abouassaly R, Steinberg JR, Lemieux M, et al.: Complications of tension-free vaginal tape surgery: a multi-institutional review. BJU Int 2004, 94:110–113.

    Article  PubMed  Google Scholar 

  26. Nguyen JK, Glowacki CA, Bhatia NN: Survey of voiding dysfunction and urinary retention after anti-incontinence procedures. Obstet Gynecol 2001, 98:1011–1017.

    Article  PubMed  CAS  Google Scholar 

  27. Glavind K, Glavind E: Treatment of prolonged voiding dysfunction after tension-free vaginal tape procedure. Acta Obstet Gynecol Scand 2007, 86:357–360.

    Article  PubMed  Google Scholar 

  28. Petrou SP, Young PR: Rate of recurrent stress urinary incontinence after retropubic urethrolysis. J Urol 2002, 167:613–615.

    Article  PubMed  Google Scholar 

  29. Palma PC, Dambros M, Riccetto CL, et al.: Transvaginal urethrolysis for urethral obstruction after anti-incontinence surgery [in Spanish]. Actas Urol Esp 2005, 29:207–211.

    PubMed  CAS  Google Scholar 

  30. Goldman HB, Rackley RR, Appell RA: The efficacy of urethrolysis without re-suspension for iatrogenic urethral obstruction. J Urol 1999, 161:196–199.

    Article  PubMed  CAS  Google Scholar 

  31. Leng WW, Davies BJ, Tarin T, et al.: Delayed treatment of bladder outlet obstruction after sling surgery: association with irreversible bladder dysfunction. J Urol 2004, 172:1379–1381.

    Article  PubMed  Google Scholar 

  32. Nitti VW, Carlson KV, Blaivas JG, Dmochowski RR: Early results of pubovaginal sling lysis by midline sling incision. Urology 2002, 59:47–51.

    Article  PubMed  Google Scholar 

  33. Kusuda L: Simple release of pubovaginal sling. Urology 2001, 57:358–359.

    Article  PubMed  CAS  Google Scholar 

  34. Thiel DD, Pettit PD, McClellan WT, Petrou SP: Long-term urinary continence rates after simple sling incision for relief of urinary retention following fascia lata pubovaginal slings. J Urol 2005, 174:1878–1881.

    Article  PubMed  Google Scholar 

  35. McLennan MT, Bent AE: Sling incision with associated vaginal wall interposition for obstructed voiding secondary to suburethral sling procedure. Int Urogynecol J Pelvic Floor Dysfunct 1997, 8:168–172.

    Article  PubMed  CAS  Google Scholar 

  36. Zubke W, Becker S, Kramer B, Wallwiener D: Persistent urinary retention after tension-free vaginal tape: a new surgical solution. Eur J Obstet Gynecol Reprod Biol 2004, 115:95–98.

    Article  PubMed  Google Scholar 

  37. Croak AJ, Schulte V, Peron S, et al.: Transvaginal tape lysis for urinary obstruction after tension-free vaginal tape placement. J Urol 2003, 169:2238–2241.

    Article  PubMed  Google Scholar 

  38. Rardin CR, Rosenblatt PL, Kohli N, et al.: Release of tension-free vaginal tape for the treatment of refractory postoperative voiding dysfunction. Obstet Gynecol 2002, 100:898–902.

    Article  PubMed  CAS  Google Scholar 

  39. Klutke C, Siegel S, Carlin B, et al.: Urinary retention after tension-free vaginal tape procedure: incidence and treatment. Urology 2001, 58:697–701.

    Article  PubMed  CAS  Google Scholar 

  40. Mishra VC, Mishra N, Karim OM, Motiwala HG: Voiding dysfunction after tension-free vaginal tape: a conservative approach is often successful. Int Urogynecol J Pelvic Floor Dysfunct 2005, 16:210–214.

    Article  PubMed  Google Scholar 

  41. Smith CP, 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, 13:55–56.

    Article  PubMed  CAS  Google Scholar 

  42. Amundsen CL, Guralnick ML, Webster GD: Variations in strategy for the treatment of urethral obstruction after a pubovaginal sling procedure. J Urol 2000, 164:434–437.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jacques Corcos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Campeau, L., Al-Afraa, T. & Corcos, J. Evaluation and management of urinary retention after a suburethral sling procedure in women. Curr Urol Rep 9, 412–418 (2008). https://doi.org/10.1007/s11934-008-0070-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-008-0070-8

Keywords

Navigation