title: Female obstruction after incontinence surgery may present different urodynamic patterns.
abstract: OBJECTIVE
  The aim of this study is to report a novel understanding of the urodynamic parameters used to diagnose iatrogenic female obstruction. There is no consensual definition of infravesical obstruction in women. Numerous criteria were designed with arbitrary cutoff values with poor clinical correlation. In order to determine the urodynamic profile of infravesical female obstruction we restricted our analysis to women who acquired voiding disturbances after being submitted to stress urinary incontinence (SUI) surgery.
  
  
  METHODS
  A total of 302 women developed obstructive symptoms or voiding difficulties after SUI operations: 176 cases had had Kelly-Kennedy operations (58.2 %), 50 had had Burch operations (16.5 %), 37 (12.2 %) had had anterior colporrhaphy + abdominal (Burch) operations, 33 (10.9 %) had had sling operations, and 8 (2.6 %) had had Marshall-Marchetti operations. Obstructive urinary symptoms started in 1-120 days after the operation and urodynamic evaluations were done after various periods of time (median 18.4 months). Clinical presentations varied widely with irritative symptoms predominating the picture.
  
  
  RESULTS
  Five patterns of pressure-flow relationships could be identified: (1) elevated pressure and poor flow (7.2 %), (2) normal pressure and poor flow (41.5 %), (3) normal pressure and flow associated with prolonged flow time (24.2 %), (4) poor detrusor contraction and elevated residual volume (12.9 %), and (5) elevated pressure and high flow (14.5 %). No relationship was established amongst the group and the Urinary Distress Inventory questionnaire.
  
  
  CONCLUSIONS
  Infravesical obstruction in women does not fit a single model. As suggested, obstruction in women must be based on broad clinical pictures and urinary complaints.
authors: Division of Neurourology and Voiding Disturbances, Beneficência Portuguesa Hospital of São Paulo, São Paulo, Brazil. paulortrodrigues@uol.com.br
authors: Paulo
authors: P
authors: Rodrigues
authors: Flávio
authors: F
authors: Hering
authors: Eli Cielici
authors: EC
authors: Dias
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007049:Iatrogenic Disease; D008875:Middle Aged; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000209:etiology* / Q000503:physiopathology*; D001743:Urinary Bladder / Q000503:physiopathology / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014555:Urination Disorders / Q000209:etiology / Q000503:physiopathology; D014563:Urodynamics / Q000502:physiology*