title: Various surgical approaches to treat voiding dysfunction following anti-incontinence surgery.
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.
authors.affiliation: Center for Urogynecology, St. Barnabas Medical Center, NJ, USA. Jsegal@sbhcs.com
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Segal
authors.forename: Andrew
authors.initials: A
authors.lastname: Steele
authors.forename: Brett
authors.initials: B
authors.lastname: Vassallo
authors.forename: Steven
authors.initials: S
authors.lastname: Kleeman
authors.forename: Andre W
authors.initials: AW
authors.lastname: Silva
authors.forename: Rachel
authors.initials: R
authors.lastname: Pauls
authors.forename: Peggy
authors.initials: P
authors.lastname: Walsh
authors.forename: Mickey
authors.initials: M
authors.lastname: Karram
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007049:Iatrogenic Disease; D008875:Middle Aged; D011788:Quality of Life; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*; D016055:Urinary Retention / Q000209:etiology / Q000601:surgery; D014621:Vagina / Q000601:surgery*