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Voiding dysfunction after surgery for stress incontinence: literature review and survey results

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Abstract

Postoperative voiding dysfunction is a potential complication of anti-incontinence procedures. Reported rates of urethral obstruction range from 5% to 20%. There is a lack of consensus in the literature regarding the appropriate evaluation and management of this distressing problem. A literature search was carried out using Medline (1966–2001) for postoperative voiding dysfunction. The key word urethrolysis was cross-referenced with surgical complications and stress urinary incontinence to identify all published English-language articles. The bibliographies of reviewed articles were searched manually. We also mailed a survey to the members of American Urogynecologic Society (AUGS) regarding their management of this problem. Overall, 262 members (31.4%) responded to the survey. Success rates reported in the literature between retropubic and vaginal techniques of urethrolysis are comparable, but morbidity is lower with the vaginal approach. The success rates are equivalent with (68%) or without (74%) resuspension following transvaginal urethrolysis. The incidence of postoperative SUI is acceptably low even without resuspension of the urethra (6% for both). Results of the AUGS survey reveal that most providers favor a transvaginal approach (74%) when performing urethrolysis, and they do not routinely resupport the bladder neck (82%).

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Abbreviations

MMK:

Marshall–Marchetti–Krantz

SUI:

Stress urinary incontinence

TVT:

Tension-free vaginal tape

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Acknowledgments

The opinions and conclusions in this article are those of the author and are not intended to represent the official position of the Department of Defense, the United States Air Force, or any other government agency.

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Authors and Affiliations

  1. Female Pelvic Medicine/Pelvic Surgery, David Grant Medical Center, 101 Bodin Circle, Travis AFB, CA 94535, USA

    James S. Dunn Jr

  2. Division of Urogynecology/Pelvic Surgery, Greater Baltimore Medical Center, 6569 North Charles Street, PPW #307, Baltimore, MD 21204, USA

    Alfred E. Bent, R. Mark Ellerkman & Clifford F. Melick

  3. Division of Urogynecology/Pelvic Surgery, Department of Obstetrics and Gynecology, University of Texas Southwest Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390–9032, USA

    Mikio A. Nihira

Authors
  1. James S. Dunn Jr
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  2. Alfred E. Bent
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  3. R. Mark Ellerkman
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  4. Mikio A. Nihira
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  5. Clifford F. Melick
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Corresponding author

Correspondence to James S. Dunn Jr.

Additional information

Editorial Comment: This is a thorough review of the current literature regarding management of the obstructed post anti-incontinence patient. It points out the lack of type A data on which to base a decision on management; however, it also demonstrates that this problem can be managed with a minimally invasive transvaginal release. This approach appears to work as well as the more invasive approach through an abdominal or suprameatal dissection. Fortunately these patients are somewhat uncommon, but they remain a challenge to the average practitioner and this paper provides some insight into how they should be surgically managed. More work in this area needs to be done before definitive recommendations can be made.

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Dunn, J.S., Bent, A.E., Ellerkman, R.M. et al. Voiding dysfunction after surgery for stress incontinence: literature review and survey results. Int Urogynecol J 15, 25–31 (2004). https://doi.org/10.1007/s00192-003-1114-8

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  • DOI: https://doi.org/10.1007/s00192-003-1114-8

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