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Various surgical approaches to treat voiding dysfunction following anti-incontinence surgery

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Abstract

Objective

The aims of this study are to report the efficacy of retropubic urethrolysis, vaginal urethrolysis, and cutting of synthetic suburethral slings in treating postoperative voiding dysfunction that occurs after anti-incontinence surgery and to report the recurrence rate of stress urinary incontinence (SUI).

Methods

All patients from January 1996 to October 2003 who presented with voiding dysfunction following an anti-incontinence procedure and who subsequently underwent either retropubic urethrolysis, vaginal urethrolysis, or synthetic suburethral sling takedown were included in the study. Pre- and postoperative irritative symptoms (urinary frequency or urgency), obstructive symptoms (hesitancy, voiding difficulty, and incomplete emptying), and stress urinary incontinence symptoms were obtained in a standardized fashion. The Incontinence Impact Questionnaire and Urogenital Distres Invetory quality of life (QOL) questionnaires were also obtained to objectify these symptoms. Other objective postoperative analysis included simple uroflowmetry, measurement of postvoid residual (PVR), and simple or subtracted cystometry.

Results

Forty-four patients were included in the study (suburethral sling takedown=14, vaginal urethrolysis=20, and retropubic urethrolysis=10), 77% of whom had objective follow-up. Preoperatively, 31 patients (70.5%) had irritative symptoms, 41 (93.2%) had obstructive symptoms, and 6 (13.6%) had symptoms of stress urinary incontinence (SUI), while postoperatively, these symptoms were found in 30 (68.2%), 11 (25.0%), and 18 (40.9%), respectively. Postoperatively, 6 patients (17.6%) had a PVR> 100 cc, 5 patients (14.7%) had a bladder contractions, and 16 patients (47.1%) demonstrated the sign or diagnosis of (SUI). Additionally, there was a statistically significant improvement in both QOL questionnaires.

Conclusions

Various surgical approaches may be used to treat voiding dysfunction following an anti-incontinence procedure. Following a vaginal or retropubic urethrolysis or takedown of a synthetic suburethral sling, obstructive symptoms are likely to improve, irritative symptoms may remain unchanged, and almost half will develop recurrence of SUI.

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References

  1. Dorflinger A, Monga A (2001) Voiding dysfunction. Curr Opin Obstet Gynecol 13:507–512

    Article  PubMed  CAS  Google Scholar 

  2. Zimmern PE, Hadley HR, Leach GE, Raz S (1987) Female urethral obstruction after Marshall–Marchetti–Krantz operation. J Urol 138:517–520

    PubMed  CAS  Google Scholar 

  3. McDuffie RW, Litin RB, Blundon KE (1981) Urethrovesical suspension (Marshall–Marchetti–Krantz). Experience with 204 cases. Am J Surg 141:297–298

    Article  PubMed  Google Scholar 

  4. Akpinalr H, Cetinel B, Demirkesen O (2000) Long-term results in Burch colposuspension. Int J Urol 7:119–125

    Article  Google Scholar 

  5. Ward KL, Hilton P, Browning J (2000) A randomized trial of colposuspension and tension free vaginal tape for primary stress incontinence. Neurourol Urodyn 19:386–388

    Google Scholar 

  6. Holschneider CH, Solh S, Lebhertz TB, Montz FJ (1994) The modified Pereyra procedure in recurrent stress urinary incontinence: a 15-year review. Obstet Gynecol 83:573–578

    Article  PubMed  CAS  Google Scholar 

  7. Horbach NS (1991) Suburethral sling procedures. In: Ostergard DR, Bent AE (eds) Urogynecology and urodynamics theory and practice, 3rd edn. Williams & Wilkins, Baltimore, pp 413–421

    Google Scholar 

  8. Karram MM, Segal JL, Vassallo BJ, Kleeman SD (2003) Complications and untoward effects of the tension-free vaginal tape procedure. Obstet Gynecol 101:929–932

    Article  PubMed  Google Scholar 

  9. Karram MM, Miklos JR (1999) Urodynamics: cystometry, voiding studies, urethral pressure profilometry and leak point pressures. In Walters MD, Karram MM, (eds) Urogynecology and reconstructive pelvic surgery, 2nd edn. Mosby, St. Louis, pp 55–93

    Google Scholar 

  10. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U (2003) The standardization of terminology in lower urinary tract function: report from the standardization sub-committee of the International Continence Society. Urology 61:37–49

    Article  PubMed  Google Scholar 

  11. Karram MM (2001) Retropubic vesicourethrolysis. In: Baggish MS, Karram MM (eds) Atlas of pelvic anatomy and gynecologic surgery, 1st edn. WB Saunders, p 194

  12. Karram MM (2001) Vaginal urethrolysis. In: Baggish MS, Karram MM (eds) Atlas of pelvic anatomy and gynecologic surgery, 1st edn. WB Saunders, pp 492–493

  13. Bump RC, Hurt WG, Elser DM, Theofrastous JP, Addison WA, Fantl JA et al (1999) Understanding lower urinary tract function in women soon after bladder neck surgery. Neurourol Urodyn 18:629–637

    Article  PubMed  CAS  Google Scholar 

  14. Klutke JJ, Klutke CG, Bergman G, Elia G (1999) Urodynamic changes in voiding after anti-incontinence surgery: an insight into the mechanism of cure. Urology 54:1003–1007

    Article  PubMed  CAS  Google Scholar 

  15. Kershen RT, Appell RA (2002) De novo urge syndrome and detrusor instability after anti-incontinence surgery: current concepts, evaluation, and treatment. Curr Urol Rep 3:345–353

    Article  PubMed  Google Scholar 

  16. Chassagne S, Bernier PA, Haab F, Roehrborn CG, Reisch JS, Zimmern PE (1998) Proposed cutoff values to define bladder outlet obstruction in women. Urology 51:408–411

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  18. Rosenblum N, Nitti VW (2001) Post-urethral suspension obstruction. Curr Opin Urol 11:411–416

    Article  PubMed  CAS  Google Scholar 

  19. Petrou SP, Brown JA, Blaivas JG (1999) Suprameatal transvaginal urethrolysis. J Urol 161:1268–1271

    Article  PubMed  CAS  Google Scholar 

  20. Nitti VW, Carlson KV, Blaivas JG, Dmochowski RR (2002) Early results of pubovaginal sling lysis by midline sling incision. Urology 59:47–52

    Article  PubMed  Google Scholar 

  21. Cross CA, Cespedes RD, English SF, McGuire EJ (1998) Transvaginal urethrolysis for urethral obstruction after anti-incontinence surgery. J Urol 159:1199–1201

    Article  PubMed  CAS  Google Scholar 

  22. Foster HE, McGuire EJ (1993) Management of urethral obstruction with transvaginal urethrolysis. J Urol 150:1448–1451

    PubMed  CAS  Google Scholar 

  23. Carr LK, Webster GD (1997) Voiding dysfunction following incontinence surgery: diagnosis and treatment with retropubic or vaginal urethrolysis. J Urol 157:821–823

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Center for Urogynecology, St. Barnabas Medical Center, NJ, USA

    Jeffrey Segal

  2. Seton Center, Good Samaritan Hospital, OH, USA

    Andrew Steele, Brett Vassallo, Steven Kleeman, Andre W. Silva, Rachel Pauls, Peggy Walsh & Mickey Karram

  3. St. Louis University, 6420 Clayton Rd., 2nd Floor, Suite 290, Saint Louis, MO, 63117, USA

    Andrew Steele

  4. Illinois Urogynecology, Ltd., 1875 Dempster St., Suite 665, Park Ridge, IL, 60068, USA

    Brett Vassallo

  5. Pacific Northwest Urogynecology, 34503 Ninth Ave S. Suite 330, Federal Way, WA, 98003, USA

    Andre W. Silva

Authors
  1. Jeffrey Segal
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  2. Andrew Steele
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  3. Brett Vassallo
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  4. Steven Kleeman
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  5. Andre W. Silva
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  6. Rachel Pauls
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  7. Peggy Walsh
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  8. Mickey Karram
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Corresponding author

Correspondence to Jeffrey Segal.

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Segal, J., Steele, A., Vassallo, B. et al. Various surgical approaches to treat voiding dysfunction following anti-incontinence surgery. Int Urogynecol J 17, 372–377 (2006). https://doi.org/10.1007/s00192-005-0018-1

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  • DOI: https://doi.org/10.1007/s00192-005-0018-1

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