Obstruction Following Anti-Incontinence Procedures: Diagnosis and Treatment with Transvaginal Urethrolysis
1994; Lippincott Williams & Wilkins; Volume: 152; Issue: 1 Linguagem: Inglês
10.1016/s0022-5347(17)32825-2
ISSN1527-3792
Autores Tópico(s)Urinary Bladder and Prostate Research
ResumoNo AccessJournal of Urology1 Jul 1994Obstruction Following Anti-Incontinence Procedures: Diagnosis and Treatment with Transvaginal Urethrolysis Victor W. Νitti, and Shlomo Raz Victor W. ΝittiVictor W. Νitti , and Shlomo RazShlomo Raz View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)32825-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail We reviewed the charts of 41 patients who underwent transvaginal urethrolysis and resuspension of the bladder neck by the Raz technique for urethral obstruction with or without stress urinary incontinence following anti-incontinence surgery. We sought to evaluate the effectiveness of the procedure as well as to determine any factors that had an effect on the outcome of surgery. Patients were evaluated for obstruction and stress urinary incontinence by history, physical examination, video urodynamics (or multichannel urodynamics plus cystogram and voiding cystourethrography) and cystoscopy. All patients reported normal emptying before the procedure that caused obstruction. Several variables were evaluated for individual predictive values for outcome, including type of surgery causing obstruction, number of previous antiincontinence procedures, urodynamic evidence of obstruction (high pressure, low flow), instability, concomitant stress urinary incontinence and total urinary retention, which were evaluated by the Fisher exact test, and the amount of post-void residual, bladder capacity, maximum detrusor pressure, maximum urinary flow and interval since surgery causing obstruction, which were evaluated by logistic regression analysis. Mean patient age was 59 years (range 26 to 86 years) and mean followup was 21 months. A total of 19 patients (46%) suffered from concurrent stress urinary incontinence, 23 (56%) had urodynamic evidence of obstruction (high pressure/low flow) and 6 (15%) had only radiographic or endoscopic evidence with a deviated or kinked urethra. Postoperatively, 29 patients (71%) voided normally without significant residuals. Eight patients (20%) remain on self-catheterization and 1 has persistent stress urinary incontinence. When individual variables were evaluated to determine the predictive values with respect to outcome of urethrolysis, only the preoperative post-void residual was statistically significant (the greater the post-void residual, the more likely was failure, p = 0.021). The presence or strength of the detrusor contraction preoperatively and pressure-flow analysis did not predict outcome. Of the patients with stress urinary incontinence 15 (79%) were cured and 3 (16%) were significantly improved with rare stress urinary incontinence not requiring protection. Overall, 33 patients (80%) had some benefit from surgery. Patients who emptied normally before an anti-incontinence procedure that causes obstruction or impaired emptying should not be excluded from urethrolysis based on low detrusor pressures or pressure-flow analysis alone. Simultaneous radiographic imaging and endoscopy may help to select certain patients with obstruction. © 1994 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByWein A (2019) Re: Suprameatal Urethrolysis with Martius Flap for Refractory Bladder Outflow Obstruction following Stress Incontinence Surgery in FemalesJournal of Urology, VOL. 201, NO. 5, (865-865), Online publication date: 1-May-2019.Crescenze I, Abraham N, Li J, Goldman H and Vasavada S (2018) Urgency Incontinence before and after Revision of a Synthetic Mid Urethral SlingJournal of Urology, VOL. 196, NO. 2, (478-483), Online publication date: 1-Aug-2016.Clifton M, Linder B, Lightner D and Elliott D (2018) Risk of Repeat Anti-Incontinence Surgery Following Sling Release: A Review of 93 CasesJournal of Urology, VOL. 191, NO. 3, (710-714), Online publication date: 1-Mar-2014.Aponte M, Shah S, Hickling D, Brucker B, Rosenblum N and Nitti V (2018) Urodynamics for Clinically Suspected Obstruction After Anti-Incontinence Surgery in WomenJournal of Urology, VOL. 190, NO. 2, (598-602), Online publication date: 1-Aug-2013.Starkman J, Duffy J, Wolter C, Kaufman M, Scarpero H and Dmochowski R (2018) The Evolution of Obstruction Induced Overactive Bladder Symptoms Following Urethrolysis for Female Bladder Outlet ObstructionJournal of Urology, VOL. 179, NO. 3, (1018-1023), Online publication date: 1-Mar-2008.Migliari R, Leone P, Berdondini E, De Angelis M, Barbagli G and Palminteri E (2018) Dorsal Buccal Mucosa Graft Urethroplasty for Female Urethral StricturesJournal of Urology, VOL. 176, NO. 4, (1473-1476), Online publication date: 1-Oct-2006.LENG W, DAVIES B, TARIN T, SWEENEY D and CHANCELLOR M (2018) DELAYED TREATMENT OF BLADDER OUTLET OBSTRUCTION AFTER SLING SURGERY: ASSOCIATION WITH IRREVERSIBLE BLADDER DYSFUNCTIONJournal of Urology, VOL. 172, NO. 4 Part 1, (1379-1381), Online publication date: 1-Oct-2004.SCARPERO H, DMOCHOWSKI R and NITTI V (2018) Repeat Urethrolysis After Failed Urethrolysis for Iatrogenic ObstructionJournal of Urology, VOL. 169, NO. 3, (1013-1016), Online publication date: 1-Mar-2003.PETROU S and YOUNG P (2018) RATE OF RECURRENT STRESS URINARY INCONTINENCE AFTER RETROPUBIC URETHROLYSISJournal of Urology, VOL. 167, NO. 2 Part 1, (613-615), Online publication date: 1-Feb-2002.AMUNDSEN C, GURALNICK M and WEBSTER G (2018) VARIATIONS IN STRATEGY FOR THE TREATMENT OF URETHRAL OBSTRUCTION AFTER A PUBOVAGINAL SLING PROCEDUREJournal of Urology, VOL. 164, NO. 2, (434-437), Online publication date: 1-Aug-2000.PETROU S, BROWN J and BLAIVAS J (2018) SUPRAMEATAL TRANSVAGINAL URETHROLYSISJournal of Urology, VOL. 161, NO. 4, (1268-1271), Online publication date: 1-Apr-1999.GOLDMAN H, RACKLEY R and APPELL R (2018) THE EFFICACY OF URETHROLYSIS WITHOUT RE-SUSPENSION FOR IATROGENIC URETHRAL OBSTRUCTIONJournal of Urology, VOL. 161, NO. 1, (196-199), Online publication date: 1-Jan-1999.NGUYEN A, MAHONEY S, MINOR L and GHONIEM G (2018) A SIMPLE OBJECTIVE METHOD OF ADJUSTING SLING TENSIONJournal of Urology, VOL. 162, NO. 5, (1674-1676), Online publication date: 1-Nov-1999.NITTI V, TU L and GITLIN J (2018) DIAGNOSING BLADDER OUTLET OBSTRUCTION IN WOMENJournal of Urology, VOL. 161, NO. 5, (1535-1540), Online publication date: 1-May-1999.CROSS C, CESPEDES R, ENGLISH S and McGUIRE E (2018) TRANSVAGINAL URETHROLYSIS FOR URETHRAL OBSTRUCTION AFTER ANTI-INCONTINENCE SURGERYJournal of Urology, VOL. 159, NO. 4, (1199-1201), Online publication date: 1-Apr-1998.Carr L and Webster G (2018) Voiding Dysfunction Following Incontinence Surgery: Diagnosis and Treatment With Retropubic or Vaginal UrethrolysisJournal of Urology, VOL. 157, NO. 3, (821-823), Online publication date: 1-Mar-1997.Ghoniem G and Elgamasy A (2018) Simplified Surgical Approach to Bladder Outlet Obstruction Following Pubovaginal SlingJournal of Urology, VOL. 154, NO. 1, (181-183), Online publication date: 1-Jul-1995. Volume 152Issue 1July 1994Page: 93-98 Advertisement Copyright & Permissions© 1994 by The American Urological Association Education and Research, Inc.Keywordsurethraurethral obstructionurodynamicsurinary retentionMetricsAuthor Information Victor W. Νitti More articles by this author Shlomo Raz More articles by this author Expand All Advertisement PDF DownloadLoading ...
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