Diagnosis and Treatment of Delayed Voiding and Outlet Obstruction after Anti-Incontinence Surgery

Abstract

In Brief Background: Surgery for urinary incontinence focuses on correcting defects of pelvic support and in the majority of women, good long-term results can be achieved. A successful outcome requires a balance between re-establishing support and avoiding obstruction. Delayed voiding and bladder outlet obstruction after anti-incontinence procedures are not uncommon. Method: The authors review the literature on the evaluation of voiding dysfunction, outlet obstruction, and therapy after anti-incontinence surgery. Discussion: The diagnosis of outlet obstruction relies on clinical suspicion, history, and physical examination confirming a retro-fixed urethra. Ancillary tests may give the surgeon some useful information. Certain groups of women may be at higher risk of voiding dysfunction after anticontinence surgery, but this remains undecided. Irritative voiding symptoms and elevated post void residuals may resolve with a period of conservative management. Urethrolysis is successful at relieving obstruction and most women will remain continent. Some women may have persistent urge symptoms or recurrent stress incontinence. Conclusion: Care should be taken not to hypersuspend the urethra and bladder during anti-incontinence surgery. Urethrolysis is successful in the majority of patients with outlet obstruction. This is a review of the literature on the evaluation of voiding dysfunction, outlet obstruction, and therapy after anti-incontinence surgery.