Tags

Type your tag names separated by a space and hit enter

[Obstruction following surgical repair of female stress urinary incontinence. Diagnosis and treatment].
Arch Esp Urol. 2002 Nov; 55(9):1107-14.AE

Abstract

OBJECTIVES

To report our experience in the diagnosis and treatment of the lower urinary tract obstruction after urinary incontinence corrective surgery, analysing the different techniques performed, retropubic or vaginal urethrolysis.

METHODS

We report a series of 14 patients with the diagnosis of obstruction after incontinence corrective surgery. They were classified in 2 groups, those who underwent retropubic procedures (5 cases) and those who underwent prolene mesh sling procedures (9 cases). We detail preoperative clinical-urodynamic parameters, and postoperative bladder outlet obstruction confirmation. Retropubic urethrolysis was performed in all patients after retropubic surgery, with the association of hysterectomy if indicated. The performance of a new sling- urethropexy was individualized. In three cases of retropubic surgery repeated urethropexy was not done. Unilateral section was performed in the sling series for all except one case of double section. A new mesh sling was performed in two cases; two cases did not undergo reoperation. Urethrolysis results were evaluated both subjectively by satisfaction degree scales and objectively by clinical-urodynamic evaluation, comparing clinical data and urodynamic parameters using the proper statistical test.

RESULTS

In the retropubic surgery group all patients are continent. Satisfaction degree is: very satisfied 3 patients and 2 quite satisfied. Two presented with voiding urgency not needing anticholinergic drugs, and their urodynamic data returned to normal values without post void residual. The obstructed patients in the sling group reported minimal urgency after urethrolysis in 2 cases. Two patients have stress urinary incontinence: one of them is better than before and refused to undergo a new operation; the other one, who repeated sling, developed a clinical picture of urgency-incontinence again, underwent second section and continues having stress urinary incontinence. Among 7 patients undergoing sling, 4 are very satisfied, 1 quite satisfied, 1 somewhat satisfied and 1 not at all satisfied. Voiding difficulties have disappeared in all cases; comparisons between pre and postoperative urodynamics maximum flow, detrusor pressure at maximum flow and postvoid residual show statistically significant differences. Post-urethrolysis parameters return to preoperative values.

CONCLUSIONS

The immediate development of symptoms after surgical correction of urinary stress incontinence is the best diagnostic criteria for obstruction. Detrusor muscle responds to obstruction, but sometimes its response is so minimal that it is difficult to diagnose urodynamically. The knowledge of preoperative values helps to confirm the diagnosis. In any case, urodynamic parameters did not influence the success of urethrolysis. Urethrolysis is an effective operation to cure symptoms secondary to obstruction after incontinence corrective surgery. When a sling has been the procedure performed, probably it is not worth to perform a standard urethrolysis; a simple section of one of the branches seems to be enough to improve symptoms. Currently, there is not scientific evidence about the convenience or not of bladder neck-urethral re-suspension after urethrolysis. The only case-scenario in which it is clearly indicated is that when there is stress incontinence in addition to obstructive symptoms.

Authors+Show Affiliations

Hospital Universitario de San Juan, Universidad Miguel Henández, San Juan, Alicante, España.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

spa

PubMed ID

12564070

Citation

Romero Maroto, Jesús, et al. "[Obstruction Following Surgical Repair of Female Stress Urinary Incontinence. Diagnosis and Treatment]." Archivos Espanoles De Urologia, vol. 55, no. 9, 2002, pp. 1107-14.
Romero Maroto J, Prieto Chaparro L, López López C, et al. [Obstruction following surgical repair of female stress urinary incontinence. Diagnosis and treatment]. Arch Esp Urol. 2002;55(9):1107-14.
Romero Maroto, J., Prieto Chaparro, L., López López, C., Quilez Fenoll, J. M., & Rodríguez Fernández, E. (2002). [Obstruction following surgical repair of female stress urinary incontinence. Diagnosis and treatment]. Archivos Espanoles De Urologia, 55(9), 1107-14.
Romero Maroto J, et al. [Obstruction Following Surgical Repair of Female Stress Urinary Incontinence. Diagnosis and Treatment]. Arch Esp Urol. 2002;55(9):1107-14. PubMed PMID: 12564070.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Obstruction following surgical repair of female stress urinary incontinence. Diagnosis and treatment]. AU - Romero Maroto,Jesús, AU - Prieto Chaparro,Luis, AU - López López,Cristobal, AU - Quilez Fenoll,José Manuel, AU - Rodríguez Fernández,Elena, PY - 2003/2/5/pubmed PY - 2003/6/21/medline PY - 2003/2/5/entrez SP - 1107 EP - 14 JF - Archivos espanoles de urologia JO - Arch Esp Urol VL - 55 IS - 9 N2 - OBJECTIVES: To report our experience in the diagnosis and treatment of the lower urinary tract obstruction after urinary incontinence corrective surgery, analysing the different techniques performed, retropubic or vaginal urethrolysis. METHODS: We report a series of 14 patients with the diagnosis of obstruction after incontinence corrective surgery. They were classified in 2 groups, those who underwent retropubic procedures (5 cases) and those who underwent prolene mesh sling procedures (9 cases). We detail preoperative clinical-urodynamic parameters, and postoperative bladder outlet obstruction confirmation. Retropubic urethrolysis was performed in all patients after retropubic surgery, with the association of hysterectomy if indicated. The performance of a new sling- urethropexy was individualized. In three cases of retropubic surgery repeated urethropexy was not done. Unilateral section was performed in the sling series for all except one case of double section. A new mesh sling was performed in two cases; two cases did not undergo reoperation. Urethrolysis results were evaluated both subjectively by satisfaction degree scales and objectively by clinical-urodynamic evaluation, comparing clinical data and urodynamic parameters using the proper statistical test. RESULTS: In the retropubic surgery group all patients are continent. Satisfaction degree is: very satisfied 3 patients and 2 quite satisfied. Two presented with voiding urgency not needing anticholinergic drugs, and their urodynamic data returned to normal values without post void residual. The obstructed patients in the sling group reported minimal urgency after urethrolysis in 2 cases. Two patients have stress urinary incontinence: one of them is better than before and refused to undergo a new operation; the other one, who repeated sling, developed a clinical picture of urgency-incontinence again, underwent second section and continues having stress urinary incontinence. Among 7 patients undergoing sling, 4 are very satisfied, 1 quite satisfied, 1 somewhat satisfied and 1 not at all satisfied. Voiding difficulties have disappeared in all cases; comparisons between pre and postoperative urodynamics maximum flow, detrusor pressure at maximum flow and postvoid residual show statistically significant differences. Post-urethrolysis parameters return to preoperative values. CONCLUSIONS: The immediate development of symptoms after surgical correction of urinary stress incontinence is the best diagnostic criteria for obstruction. Detrusor muscle responds to obstruction, but sometimes its response is so minimal that it is difficult to diagnose urodynamically. The knowledge of preoperative values helps to confirm the diagnosis. In any case, urodynamic parameters did not influence the success of urethrolysis. Urethrolysis is an effective operation to cure symptoms secondary to obstruction after incontinence corrective surgery. When a sling has been the procedure performed, probably it is not worth to perform a standard urethrolysis; a simple section of one of the branches seems to be enough to improve symptoms. Currently, there is not scientific evidence about the convenience or not of bladder neck-urethral re-suspension after urethrolysis. The only case-scenario in which it is clearly indicated is that when there is stress incontinence in addition to obstructive symptoms. SN - 0004-0614 UR - https://www.unboundmedicine.com/medline/citation/12564070/[Obstruction_following_surgical_repair_of_female_stress_urinary_incontinence__Diagnosis_and_treatment]_ L2 - http://www.aeurologia.com/articulo_prod.php?id_art=7975348131978 DB - PRIME DP - Unbound Medicine ER -