Bladder Outlet Obstruction
Bladder outlet obstruction in the female is rare. The patient may complain of symptoms of obstruction such as the need to strain, difficulty in starting the stream, interrupted or prolonged stream, or the sensation of incomplete emptying. The patient’s symptoms may not correlate with the residuals of urine, which can be low or high. Patients with chronic retention can present with minimal symptoms of obstruction but a significant residual of urine.
KeywordsUrinary obstruction Urethral stricture Bladder neck obstruction Ureterolysis Urethroplasty
Suprameatal urethrolysis and insertion of retropubic Martius flap. The patient is in retention and self-catheterization due to urethral obstruction. An incision is made anterior to the urethra directly toward the anterior pubic bone. The periosteum is exposed and the urethra retracted inferiorly. With sharp dissection, the retropubic is entered by detaching the pubourethral fascia from flesh under the inferior margin of the pubic bone. A Martius flap is prepared, rotated, and transferred anterior to the urethra into the retropubic space, where it is fixed by sutures to the anterior bladder wall. Sutures approximate the pubourethral fascia to the urethra. The vaginal incision is closed (MP4 237199 kb)