Surgical and nonsurgical approaches to treat voiding dysfunction following antiincontinence surgery

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To review conservative and operative approaches to treat voiding dysfunction after antiincontinence operation. Voiding dysfunction is a complication of antiincontinence surgery. Unfortunately, there are no consistent preoperative findings that can predict this morbidity. By design, antiincontinence surgery must create some degree of obstruction during the nonvoiding phase in order to be effective. When the continence operation overcorrects anatomy, however, de-novo irritative and/or obstructive symptoms may develop. The traditional pubovaginal sling is more likely to produce voiding dysfunction than is colposuspension or the midurethral sling. Fortunately, most voiding dysfunction is transient and resolves spontaneously in a few days to weeks. Clean intermittent self-catheterization is the mainstay of conservative management. When symptoms persist, either sling incision or urethrolysis may be performed. The simple incision involves cutting the sling in the midline, while formal urethrolysis entails dissection, entry into the retropubic space, and mobilization of the urethra from the pubic bone. Voiding dysfunction after antiincontinence surgery is usually transient, but if surgery is required because of a persistence of symptoms then simple sling incision and vaginal urethrolysis have a high success rate and recurrent stress urinary incontinence is infrequent.