The value of surgical release after obstructive anti-incontinence surgery: An aid for clinical decision making.

Abstract

To present satisfaction rates after surgical release of obstructive anti-incontinence surgery, to look for predictive factors for outcome and to define the optimal moment to perform the surgical release. We reviewed the charts of 87 women at first, second, and last follow-up at a median of 2 (0.5-7), 4 (2-12), and 108 (29-156) months after surgical release. Obstruction was defined as urinary retention, straining to void after overcorrected anti-incontinence treatment or urodynamic bladder outlet obstruction. Patients' satisfaction was assessed using a 4 point Likert scale. Satisfaction rates at first, second, and last follow-up were 66% (n = 54/82), 54% (n = 37/69), and 74% (n = 43/58) respectively. Postoperatively, patients complained about overactive bladder (OAB) symptoms in 37% (n = 30/81) and SUI in 28% (n = 23/81) at first follow-up and in 41% (n = 28/68) and 27% (n = 18/68) at second follow-up for OAB symptoms and stress urinary incontinence (SUI) respectively. When surgical release was performed more than 180 days after original surgery, less SUI (P = 0.008) was reported. When performed within 70 days in patients without pre-operative OAB symptoms, less post-operative OAB symptoms (P = 0.05) were reported. Surgical release can be very successful in relieving obstruction due to bladder outlet obstruction (BOO) after anti-incontinence surgery. Persistent OAB symptoms and recurrent SUI are the main reasons for being dissatisfied. To lower the odds for recurrent SUI, surgical release should be performed more than 180 days after original surgery. Patients without pre-operative OAB symptoms are at higher risk of developing post-operative OAB symptoms when treatment is delayed more than 70 days.