Transvaginal urethrolysis for urethral obstruction after anti-incontinence surgery.
OBJECTIVE
Urethral obstruction following a stress incontinence procedure occurs in 5 to 20% of patients. We examine the success of transvaginal urethrolysis in resolving voiding dysfunction.


METHODS
A retrospective chart review was performed on 39 patients who had undergone transvaginal urethrolysis for urethral obstruction following an anti-incontinence procedure. Preoperatively, a history was taken, and pelvic examination and either video urodynamics or cystoscopy were done.


RESULTS
All 39 patients complained of urge incontinence, 13% had urinary retention, 51% had incomplete bladder emptying and 36% voided to completion but had irritative voiding symptoms. Previous surgery included retropubic urethropexy in 41% of the cases, pubovaginal sling in 38% and bladder neck suspension in 21%. Mean length of followup after urethrolysis was 16 months. Of the 39 patients 33 (85%) had resolution of urge incontinence but 5 still required occasional intermittent catheterization. The remaining 6 patients had continued urge incontinence. An augmentation procedure was performed in 4 patients with improvement of symptoms.


CONCLUSIONS
Our data support transvaginal urethrolysis for the treatment of iatrogenic urethral obstruction. It is a rapid, effective and minimally invasive technique that should be considered if voiding dysfunction does not resolve spontaneously.
Cross
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CA
Department of Obstetrics, Gynecology and Reproductive Medicine, University of Texas Medical School at Houston, USA.
Cespedes
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RD
English
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SF
McGuire
E J
EJ
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods; D014524:Urethral Obstruction / Q000209:etiology / Q000601:surgery*; D014549:Urinary Incontinence / Q000601:surgery*; D014621:Vagina