title: Can urethrolysis resolve outlet obstruction related symptoms after Burch colposuspension for stress urinary incontinence?
abstract: OBJECTIVE
  Bladder outlet obstruction may occur after any incontinence surgery and may present as OAB, hesitancy and or the feeling of incomplete emptying. Aim of this study was to analyze the clinical and urodynamical outcome after urethrolysis in patients presenting with various clinical symptoms after Burch colposuspension for stress urinary incontinence.
  
  
  METHODS
  Between January 2005 and December 2014, all patients who presented with symptoms and with bladder outlet obstruction were included. All patients had undergone Burch or Cowan colposuspension for stress urinary incontinence previously. Primary endpoint was the visual analogue scale (VAS) as measurement of patient perceived disease impact. Secondary endpoints were the various domains of the King's Health Questionnaire, urodynamic parameters as detrusor pressure at maximum flow, residual urine and sonographic bladder wall thickness before and six months after intervention.
  
  
  RESULTS
  Seventy-two female patients were included in this study whereof 42 suffered from urgency and urge incontinence, 20 from hesitancy and/or slow stream, seven from residual urine of more than 100ml and three from a combination of urgency and residual urine. VAS improved significantly (p<0.0001). Quality of life as determined by the King's Health Questionnaire improved for the domains general health, role limitations, emotions, physical limitations, personal limitations and incontinence impact significantly. Micturition pressure dropped significantly from 43cmH2O (95% CI 19-59cmH2O) to 18cmH2O (95% CI 16-23.5 H2O). Residual urine changed from 110ml (range 20-380ml) to 32ml (20-115ml). Bladder wall thickness decreased from 7mm (95% CI 6.235-7.152) to 5mm (95% CI 5.037-5.607; p<0.01).
  
  
  CONCLUSIONS
  Urethrolysis may resolve patients' symptoms and lower micturition pressure but irritative symptoms may persist.
authors.affiliation: Kantonsspital Schaffhausen, Switzerland.
authors.forename: Georg
authors.initials: G
authors.lastname: Giannis
authors.affiliation: Kantonsspital Aarau, Switzerland.
authors.forename: Evgenia
authors.initials: E
authors.lastname: Bousouni
authors.affiliation: Frauenklinik, Urogynaecology, Inselspital Bern and University of Bern, Switzerland.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Mueller
authors.affiliation: Frauenklinik, Urogynaecology, Inselspital Bern and University of Bern, Switzerland.
authors.forename: Sara
authors.initials: S
authors.lastname: Imboden
authors.affiliation: Frauenklinik, Urogynaecology, Inselspital Bern and University of Bern, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Mohr
authors.affiliation: Frauenklinik, Urogynaecology, Inselspital Bern and University of Bern, Switzerland.
authors.forename: Luigi
authors.initials: L
authors.lastname: Raio
authors.affiliation: Frauenklinik, Urogynaecology, Inselspital Bern and University of Bern, Switzerland. Electronic address: annette.kuhn@insel.ch.
authors.forename: Annette
authors.initials: A
authors.lastname: Kuhn
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011788:Quality of Life; D019651:Plastic Surgery Procedures; D012086:Reoperation; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D001748:Urinary Bladder Neck Obstruction / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D053202:Urinary Incontinence, Urge / Q000601:surgery*; D016055:Urinary Retention / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures; D014621:Vagina / Q000601:surgery*
keywords: Burch colposuspension; OAB; Quality of life; Residual urine; Urethrolysis