Management of voiding dysfunction after anti-incontinence operation

Abstract

With the increasing number of surgery for incontinence, voiding dysfunction after anti-incontinence surgery will continue to be a problem. The patient with postoperative voiding dysfunction may present with primarily storage symptoms or voiding symptoms, or a combination of both. Detailed knowledge of the preoperative voiding status may aid in the diagnosis of voiding dysfunction. Diagnosis is based on history, physical examination, urinalysis and postvoid residual volume, but additional informations from urodynamic study and cystoscopy are useful. Patients with postoperative voiding dysfunction should be initially treated conservatively with intermittent or continuous catheterization, fluid restriction, anticholinergics and pelvic floor physiotherapy. When conservative treatment fails, surgical intervention should be done. It is important to distinguish between midurethral sling and other procedures because the timing and type of intervention vary. In case of midurethral sling, loosening or cutting the tape has had excellent results. Prevention of obstruction during surgery may be the best way to avoid reoperation.