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Repeat urethrolysis after failed urethrolysis for iatrogenic obstruction.
J Urol. 2003 Mar; 169(3):1013-6.JU

Abstract

PURPOSE

Bladder outlet obstruction is a potential complication of all stress incontinence surgery. Urethrolysis successfully relieves 65% to 93% of cases. We determined the success of repeat urethrolysis after failed initial urethrolysis to relieve obstruction.

MATERIALS AND METHODS

We reviewed the charts of 24 women who underwent repeat urethrolysis for iatrogenic obstruction after at least 1 previous attempt. Aggressive repeat urethrolysis was performed via a retropubic or transvaginal route depending on the clinical scenario and surgeon discretion. Outcomes measured were patient ability to void spontaneously without catheterization, decreased post-void residual urine and resolution of lower urinary tract symptoms, particularly urge incontinence.

RESULTS

Mean patient age was 55 years (range 38 to 80). The initial incontinence procedure was a pubovaginal sling in 10 cases, retropubic suspension in 9, needle suspension in 4 and anterior colporrhaphy in 1. A total of 23 patients had previously undergone transvaginal urethrolysis, while 1 had undergone retropubic urethrolysis. The repeat procedure was retropubic in 12 women (50%), transvaginal in 10 (42%) and combined in 2 (8%). Mean time between initial and repeat urethrolysis was 9 months (range 1 to 3). Mean followup was 14 months. Postoperatively 20 of the 22 patients (91%) who were catheter dependent no longer needed to catheterize. Post-void residual urine normalized in the 2 patients who had not been catheter dependent but who had had elevated post-void residual urine. Thus, repeat urethrolysis successfully eliminated urinary retention in 22 of the 24 cases (92%). Mean post-void residual urine before and after repeat urethrolysis was 334 versus 44 ml. (p <0.001). Irritative symptoms and urge incontinence completely resolved in 12% of cases, were improved and required medication in 69% and remained the same in 19%. No patient had new onset irritative symptoms. Stress urinary incontinence recurred in 4 of the 22 women (18%) and persisted in the 2 in whom it had been present before urethrolysis.

CONCLUSIONS

Aggressive repeat urethrolysis can be highly successful for relieving iatrogenic retention. Complete resolution of irritative symptoms and urge incontinence is less likely. Recurrent stress urinary incontinence is similar to that after primary urethrolysis.

Authors+Show Affiliations

Department of Urology, New York University School of Medicine, New York, New York, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12576834

Citation

Scarpero, Harriette M., et al. "Repeat Urethrolysis After Failed Urethrolysis for Iatrogenic Obstruction." The Journal of Urology, vol. 169, no. 3, 2003, pp. 1013-6.
Scarpero HM, Dmochowski RR, Nitti VW. Repeat urethrolysis after failed urethrolysis for iatrogenic obstruction. J Urol. 2003;169(3):1013-6.
Scarpero, H. M., Dmochowski, R. R., & Nitti, V. W. (2003). Repeat urethrolysis after failed urethrolysis for iatrogenic obstruction. The Journal of Urology, 169(3), 1013-6.
Scarpero HM, Dmochowski RR, Nitti VW. Repeat Urethrolysis After Failed Urethrolysis for Iatrogenic Obstruction. J Urol. 2003;169(3):1013-6. PubMed PMID: 12576834.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Repeat urethrolysis after failed urethrolysis for iatrogenic obstruction. AU - Scarpero,Harriette M, AU - Dmochowski,Roger R, AU - Nitti,Victor W, PY - 2003/2/11/pubmed PY - 2003/2/27/medline PY - 2003/2/11/entrez SP - 1013 EP - 6 JF - The Journal of urology JO - J Urol VL - 169 IS - 3 N2 - PURPOSE: Bladder outlet obstruction is a potential complication of all stress incontinence surgery. Urethrolysis successfully relieves 65% to 93% of cases. We determined the success of repeat urethrolysis after failed initial urethrolysis to relieve obstruction. MATERIALS AND METHODS: We reviewed the charts of 24 women who underwent repeat urethrolysis for iatrogenic obstruction after at least 1 previous attempt. Aggressive repeat urethrolysis was performed via a retropubic or transvaginal route depending on the clinical scenario and surgeon discretion. Outcomes measured were patient ability to void spontaneously without catheterization, decreased post-void residual urine and resolution of lower urinary tract symptoms, particularly urge incontinence. RESULTS: Mean patient age was 55 years (range 38 to 80). The initial incontinence procedure was a pubovaginal sling in 10 cases, retropubic suspension in 9, needle suspension in 4 and anterior colporrhaphy in 1. A total of 23 patients had previously undergone transvaginal urethrolysis, while 1 had undergone retropubic urethrolysis. The repeat procedure was retropubic in 12 women (50%), transvaginal in 10 (42%) and combined in 2 (8%). Mean time between initial and repeat urethrolysis was 9 months (range 1 to 3). Mean followup was 14 months. Postoperatively 20 of the 22 patients (91%) who were catheter dependent no longer needed to catheterize. Post-void residual urine normalized in the 2 patients who had not been catheter dependent but who had had elevated post-void residual urine. Thus, repeat urethrolysis successfully eliminated urinary retention in 22 of the 24 cases (92%). Mean post-void residual urine before and after repeat urethrolysis was 334 versus 44 ml. (p <0.001). Irritative symptoms and urge incontinence completely resolved in 12% of cases, were improved and required medication in 69% and remained the same in 19%. No patient had new onset irritative symptoms. Stress urinary incontinence recurred in 4 of the 22 women (18%) and persisted in the 2 in whom it had been present before urethrolysis. CONCLUSIONS: Aggressive repeat urethrolysis can be highly successful for relieving iatrogenic retention. Complete resolution of irritative symptoms and urge incontinence is less likely. Recurrent stress urinary incontinence is similar to that after primary urethrolysis. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/12576834/Repeat_urethrolysis_after_failed_urethrolysis_for_iatrogenic_obstruction_ L2 - https://www.jurology.com/doi/10.1097/01.ju.0000042452.65641.05?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -