Postoperative Retention Research Articles

Catheter‐less robotic radical prostatectomy using a custom‐made synchronous anastomotic splint and vesical urinary diversion device: report of the initial series and perioperative outcomes

To study the feasibility of avoiding a urethral catheter after robotic radical prostatectomy by using suprapubic diversion with a urethral splint, as urethral catheterization is often a source of major discomfort and pain to the patient, and can cause more concern to the patient than the procedure; we present the outcomes of a pilot study. This pilot study involved 30 patients; in group 1 (the study group of 10 patients) we used a custom-made suprapubic catheter which provided a small anastomotic splint, multiple holes for drainage and the ability to retract the splint to give a voiding trial before removing the drainage device. Group 2 was a control group of 20 patients who had standard urethral catheterization with an 18 F Silastic Foley catheter. Demographic, intraoperative and outcome data were measured and analysed. Urethral symptoms were recorded using a specially developed questionnaire. The two groups were comparable in terms of age, serum prostate specific antigen level, body mass index, Gleason scores, tumour stage, operative duration, amount of bleeding, console times, anastomotic leakage and postoperative retention rates. The study group had significantly less penile shaft or tip pain and discomfort during walking or sleeping. No patient in either group had haematuria or clot retention requiring irrigation. Urethral catheter-less robotic radical prostatectomy is feasible. The advantages are decreased penile shaft and tip pain, and decreased patient discomfort and an earlier return of continence.

Global retrograde amnesia but selective anterograde amnesia after frontal–temporal disconnection in monkeys

Prefrontal cortex and inferior temporal cortex interact in support of a wide variety of learning and memory functions. In macaque monkeys, a disconnection of prefrontal and temporal cortex produces severe new learning impairments in a range of complex learning tasks such as visuo-motor conditional learning and object-in-place scene learning. The retrograde effects of this disconnection, however, have never been fully examined. We therefore assessed the postoperative retention of 128 preoperatively learned object discrimination problems in monkeys with prefrontal–temporal disconnection using 1 trial postoperative retention tests. Because previous experiments have suggested that both spatial and temporal factors may be important in engaging frontal–temporal interaction we used object discrimination problems with a variety of spatial and temporal properties. Postoperatively, although monkeys with prefrontal–temporal disconnection displayed a retrograde amnesia for all problem types, subsequent assessments of new learning revealed selective anterograde amnesia, which was limited to problems in which objects were presented as serial compound stimuli. The pattern of broad retrograde amnesia with selective anterograde amnesia contrasts with recent data from monkeys with lesions which disrupt subcortical–cortical connectivity and which show the opposite pattern, namely no retrograde amnesia but severe anterograde amnesia. These results support the hypothesis that visual memory acquisition is supported by subcortical–cortical interactions while the retrieval of visual memories normally depends on the interaction between prefrontal cortex and inferior temporal cortex.

Intraosseous Venography with Carbon Dioxide in Percutaneous Vertebroplasty: Carbon Dioxide Retention in Renal Veins

The objective of the present study was to determine the frequency of gas retention in the renal vein following carbon dioxide intraosseous venography in the prone position and, while citing references, to examine its onset mechanisms. All percutaneous vertebroplasties performed at our hospital from January to December 2005 were registered and retrospectively analyzed. Of 43 registered procedures treating 79 vertebrae, 28 procedures treating 54 vertebrae were analyzed. Vertebral intraosseous venography was performed using carbon dioxide as a contrast agent in all percutaneous vertebroplasty procedures. In preoperative and postoperative vertebral CT, gas retention in the renal vein and other areas was assessed. Preoperative CT did not show gas retention (0/28 procedures; 0%). Postoperative CT confirmed gas retention in the renal vein in 10 of the 28 procedures (35.7%). Gas retention was seen in the right renal vein in 8 procedures (28.6%), in the left renal vein in 5 procedures (17.9%), in the left and right renal veins in 3 procedures (10.7%), in vertebrae in 22 procedures (78.6%), in the soft tissue around vertebrae in 14 procedures (50.0%), in the spinal canal in 12 procedures (42.9%), and in the subcutaneous tissue in 5 procedures (17.9%). In conclusion, in our study, carbon dioxide gas injected into the vertebra frequently reached and remained in the renal vein.

Minimally invasive treatment of female stress urinary incontinence: 100 cases using SPARC sling

Assess the suitability of SPARC sling as a minimally invasive operation for female stress urinary incontinence. One hundred consecutive patients were evaluated over 45-month period. All had stress urinary incontinence (SUI), proven on urodynamics and cough stress test, independently or combined with urge incontinence but with predominantly SUI. King's Health Questionnaire 1993 (KHQ) and SF36 Health Survey forms were completed pre and post operatively. Peri-operative features, complications and results were recorded. Mean follow-up was 20 months. SUI was cured or significantly reduced in 88% of cases. Role Limitations and Severity Measures (as per KHQ) were considerably reduced. Post-op retention in 11% cases resolved spontaneously within 2 weeks. One case had readjustment of sling. Complications were small in number and minor in nature. SPARC sling is highly effective with low complication rates. It is an alternative to tension free vaginal tape.

A Study into Postoperative Urine Retention in the Recovery Ward

ABSTRACTOn the basis of hypothesis from our own practice, a study dealing with postoperative urine retention (PUR) in patients in the recovery ward was completed during 2006 in Odense University Hospital.Three hundred and seven patients took part in the study with a view to monitoring the occurrence of PUR and to identify the relationship between risk factors and the development of PUR. Defining PUR as >300 mL in the bladder with the inability to urinate, the study showed that 28.7% of the patients had PUR at arrival to the recovery ward.The study showed a positive correlation between patients with ascending age, rising anaesthesia duration, regional anaesthesia (RA) and developing PUR.PUR occurred in half of the patients with diabetes and approximately half of the patients treated with ephedrine. Furthermore, the type of surgery had significance, as considerably more patients with plastic and orthopaedic surgery developed PUR. On the other hand, the study showed no correlation between subjective symptoms, e.g. like a strong desire to void, and the occurrence of PUR.The results highlight the necessity for greater attention to screening patients for PUR.

Haemorrhage and nerve damage as complications of TVT-O procedure: case report and literature review

The transobturatorial vaginal tape procedure is associated with little complication rate. Bladder perforation, urethral invasion, vaginal erosion, postoperative bladder retention, de novo incontinence and retropubic pain and haematoma are the most reported complications. The aim of this article is to present an uncommon complication in a patient operated by transobturator vaginal tape with an inside-outside route.

A comparison of urinary complications following total laparoscopic radical hysterectomy and laparoscopic pelvic lymphadenectomy to open abdominal surgery

Objective The objective of this study was to compare total laparoscopic radical hysterectomy (TLRH) and laparoscopic pelvic lymphadenectomy (LPS) to total abdominal radical hysterectomy (TARH) and pelvic lymphadenectomy (LPT) in terms of urinary tract lesions and postoperative urinary retention. Methods Starting in 2004, we treated all early stage cervical cancer patients with TLRH and LPS. The control group for this analysis was a historical cohort of patients treated with TARH + LPT. Within the TLRH + LPS group, we assessed whether the width of parametrial tissue removed was a risk factor for urinary tract injuries or postoperative urinary retention. Results Fifty women were included in the TLRH + LPS group and forty-eight were included in the TARH + LPT group. There were no conversions from laparoscopy to laparotomy. There was no statistically significant difference in intraoperative urinary complications between the groups. Four (8%) intraoperative urinary tract injuries in the LPS (3 cystotomies and 1 ureteral lesions all repaired laparoscopically) and 2 (4.2%) in the LPT group (2 cystotomies) occurred ( p = 0.68). Similarly, there was no statistically significant difference in postoperative urinary complications between groups. Urinary postoperative complications were: 1 (2%) ureterovaginal and 1 vesicovaginal fistulas, 1 delayed ureteric fistula in LPS group vs. 0 in LPT group ( p = 0.24). Urinary retention was complained by 7 (14%) and 7 (14.6%) patients in LPS and LPT groups respectively ( p = 1.00). The average width of parametrial tissue removed in the LPS group was 32.2 + 14.0 mm in patients with vs. 39.5 + 13.6 mm in patients without urinary complications ( p = 0.11). Conclusions A laparoscopic approach is comparable to the laparotomy in terms of urinary lesions and postoperative retention. The width of parametrium removed does not affect the risk of urinary lesions or postoperative retention.

Editorial Comment on: Prospective Clinical Trial Comparing Obtape® and DUPS to TVT: One-year Safety and Efficacy Results

Suburethral sling procedures are specifically designed to address both urethral hypermobility and intrinsic sphincteric deficiency components of stress urinary incontinence (SUI) in women. Although further studies are needed to establish their long-term efficacy and safety, these procedures seem more efficient than the ones adopted in the era before the development of tension-free vaginal tape (TVT). In their paper, Andonian et al [1] report the outcomes of three types of suburethral sling to treat female SUI. In a prospective, randomised, controlled, clinical trial Obtape and DUPS were compared to the original TVT procedure. The DUPS arm of the randomised clinical trial (RCT) was discontinued after 32 patients because they observed a high postoperative retention rate (18.8%) combined with suprapubic discomfort. This study demonstrates that, at 1-yr follow-up, no statistically significant differences in cure rates were evident, but Obtape, DUPS, and TVT were associated with postoperativecomplications in 14%, 28%, and 8% of patients, respectively (p 0.025). TVT was the only procedure associated with bladder perforation, and this complication was higher in patients who had undergone previous surgery [1]. The perivesical tissue hydrodissection due to local anaesthesia could reduce the risk of bladder perforation, but I agree with the authors that regional anaesthesia is better tolerated by patients. A recurrent SUI is reported in 23 patients (12.1%), but the outcome after retropubic and trans-obturator procedures is not available, so I suppose that the authors do not find any significant differences [1]. The International Consultation on Incontinence underlines that TVT procedure on recurrent SUI has shown promising results, whereas few data on this issue regarding the other type of suburethral slings efficacy are available in literature [2]. Urinary incontinence and pelvic organ prolapse (POP) commonly coexist [3]. SUI is observed in up to 60% of women with POP and prolapse in up to 40% of women presenting with SUI [3–5]. In this study a concomitant prolapse surgery (anterior and posterior colporrhaphy and vaginal hysterectomy) was performed in 29 patients (15.2%) and was associated with postoperative retention only in the Obtape group (38% vs. 4%) [1]. There are no data in the literature, obtained from comparative RCTs, that could clarify whether POP surgery and antiincontinence surgery have to be performed at the same or different times and which anti-incontinence procedure is better. The authors report no statistically significant differences among the three groups in terms of persistent or de novo urgency, but the overall rate of the persistent urgency ranges from 19% to 23% [1]. Recently, Costantini et al [6] reported on the efficacy of the retropubic or trans-obturator approach in the treatment of mixed urinary incontinence (MUI). They compared TVT and trans-obturator tape procedures and found that at a mean follow-up of 24 mo the outcome after TVT seems slightly worse in patients with MUI. ‘‘Urgency remains a postoperative problem especially in the TVT group’’ [6]. IbelievethatmulticentreRCTswithlongerfollowup are needed to establish which suburethral sling procedure in the treatment of MUI or recurrent SUI is better. In addition, comparative RCTs are needed to determine whether POP surgery and the retropubic or trans-obturator anti-incontinence procedure should be performed simultaneously or not.

Prospective Clinical Trial Comparing Obtape® and DUPS to TVT: One-Year Safety and Efficacy Results

ObjectivesObtape and DUPS are modifications of the original TVT procedure. To test these new products in terms of safety and efficacy, we designed a prospective clinical trial with a follow-up of at least 1 yr. MethodsWe randomized 190 consecutive females with SUI for this study. They were evaluated by history, ICIQ-SF, physical examination, cystoscopy, UDS, and the 1-h pad test. Patients were reevaluated at 1, 6, and 12 mo. The ICIQ-SF and pad test were repeated at 1-yr follow-up. ResultsThere were 78, 32, and 80 patients in the Obtape, DUPS, TVT arms, respectively. An interim analysis after 32 patients in each arm indicated postoperative retention rates of 3 (9.4%), 6 (18.8%), and 4 (12.5%) patients in Obtape, DUPS, and TVT groups, respectively. Because of higher retention rate and suprapubic discomfort, DUPS was discontinued. At the end of the study, complete retention rates were 6 (7.8%), 6 (18.8%), and 6 (7.5%) in Obtape, DUPS, and TVT, respectively. TVT was the only procedure with bladder perforations at a rate of 14%. However, Obtape and DUPS were associated with more postoperative complications including complete retention, urethrolysis, hematoma, mesh erosion, UTI, and wound infection (13%, 28%, and 8%; p≤0.025). At 1 yr, 83%, 94%, and 86% of patients in the Obtape, DUPS, and TVT groups were objectively cured (p>0.05). ConclusionsTVT was the only procedure associated with bladder perforation, but there were more postoperative complications with Obtape and DUPS. No statistically significant differences in cure rates were observed at 1-yr follow-up. Longer follow-up is needed to confirm these results.

Transobturator tape procedure outcome: a clinical and quality of life analysis of a 1-year follow-up

To report the results obtained with the transobturator sub-urethral tape (TOT) for the surgical treatment of stress urinary incontinence (SUI) after 1 year follow-up. Ninety-three patients diagnosed with SUI or mixed urinary incontinence (MUI) underwent a TOT procedure associated to prolapse surgery, if necessary. Pre-operative quality of life (QoL) was assessed with the Urogenital Distress Inventory Short Form (UDI-6)/Incontinence Impact Questionnaire Short Form (IIQ-7) questionnaires. Surgical and early complications were monitored. A stress test and an urodynamic test if urge incontinence de novo appeared were performed at 1 year follow-up. UDI-6/IIQ-7 questionnaires and SUI symptoms were recorded. Patients' characteristics, pre-operative quality of life and urodynamic evaluation were similar in the TOT and in the pelvic floor surgery group. From the sample, 15% had post-operative retention and 10% had vaginal erosion. The global rate of objective cure was 97% in both groups. The scores of the QoL questionnaires were worse by 9% and 10% with the procedure, respectively. Patients with urodynamic (MUI) or persistence of SUI symptoms (10%) did not reach a significant improvement, although patients with urge incontinence de novo (10%) did. The TOT procedure is safe and effective. Results showed that the association to pelvic floor surgical techniques did not diminish 1 year later. The stress test outcome assessment can overestimate the results, compared to the QoL assessment. In our report, the MUI did not improve with this surgical approach. Our results highlight the necessary employment of both the objective testing and the patient's opinion of her symptoms during daily life.

Post-Hemorrhoidectomy Hemorrhage and Associated Factors

Purpose: Post-hemorrhoidectomy hemorrhage is a well-documented complication. However, little is known about any association between post-operative hemorrhage and duration of stay in the hospital, readmission rate, type of hemorrhoidectomy, concomitant retention of urine and opioid analgesia requirement.We aimed to assess any such association between post-hemorrhoidectomy hemorrhage and other factors. Methods: All hemorrhoidectomies that took place between September 1999 and August 2004 were considered for the study. Duration of stay was measured in terms of days. All readmissions that were relevant to original hemorrhoidectomy were included. Type of hemorrhoidectomy was classified as open and stapled. Opioid analgesia included morphine, pethidine and tramadol. Hemorrhage was categorized as mild (<100 ml), moderate (100–300 ml) and severe (>300 ml). Results: A total of 262 hemorrhoidectomies took place. Occurrences of mild, moderate and severe post-operative hemorrhage were 28 (10.7%), 3 (1.1%) and 3 (1.1%) respectively. Three patients required blood transfusion. Those who developed post-operative hemorrhage stayed significantly longer (N = 4.5 ± 0.3 days), compared to those who did not (N = 2.5 ± 0.08 days) [p < 0.0000001]. Readmissions amounted to 26 cases (9.9%). However there was no significant difference in the occurrence of readmissions of patients who did not develop post-operative hemorrhage (N = 24; 10.5% of 228), than those who did (N = 2; 5.9% of 34) [p= 0.39]. Post-operative hemorrhage was significantly lower in stapled group (N = 7; 6.8% of 103), than open group (N = 27; 17% of 159) [p= 0.017]. The frequency of post-operative hemorrhage was not significantly different amongst those who developed post-operative retention of urine (N = 8; 20% of 40), than those who did not (N = 26; 11.7% of 222) [p= 0.15]. Opioid requirement was significantly more amongst those who developed post-operative hemorrhage (N = 22; 64.7% of 34), compared to those who did not (N = 82; 36% of 228) [p= 0.001]. Conclusions: The study had showed that post-operative hemorrhage following hemorrhoidectomy had significant association with duration of stay, type of hemorrhoidectomy and opioid analgesia. However, no significant association was noted with sex, readmission rate and concomitant urinary retention. These have important implications on counseling, choice of operation and management issues.

Hippocampal lesions impair performance on a conditional delayed matching and non-matching to position task in the rat

The hippocampus is thought to be involved in a range of cognitive processes, from the ability to acquire new memories, to the ability to learn about spatial relationships. Humans and monkeys with damage to the hippocampus are typically impaired on delayed matching to sample tasks, of which the operant delayed matching to position task (DMTP) is a rat analogue. The reported effects of hippocampal damage on DMTP vary, ranging from delay-dependent deficits to no deficit whatsoever. The present study investigates a novel memory task; the conditional delayed matching/non-matching to position task (CDM/NMTP) in the Skinner box. CDM/NMTP uses the presence of specific stimulus cues to signify whether a particular trial is matching or non-matching in nature. Thus, it incorporates both the task contingencies within one session, and supplements the requirement for remembering the side of the lever in the sample phase with attending to the stimulus and remembering the conditional discrimination for the rule. Rats were trained preoperatively and the effects of bilateral excitotoxic lesions of the hippocampus were examined on postoperative retention of the task. Rats with lesions of the hippocampus incurred a significant impairment on the task that was manifest at all delays intervals. Despite a bias towards matching during training, trials of either type were performed with equivalent accuracy and neither rule was affected differentially by the lesion. This task may prove useful in determining the cognitive roles of a range of brain areas.

Significance of tension in tension-free mid-urethral sling procedures: a preliminary study

We report the results of the release and tape-shortening techniques in polypropylene pubovaginal slings. Of female patients who had undergone mid-urethral sling procedures [tension-free vaginal tape procedure and suburethral polypropylene (SPARC)], in cases in which postoperative retention occurred, the patients were offered release or tape cutting. Women reporting postoperative urinary incontinence underwent a tape-shortening procedure. In these patients, the tape was shortened by the use of clips. Mean follow-up time after the release and/or the shortening operations was 9.9 months (range 6-18). A total of 15 women, ranging from 41 to 75 years old (mean 58.3) were included in this study. Upon the latest follow-up, six women exhibited prolonged urinary retention and subsequently underwent a release procedure (n=5) or a tape-cutting procedure (n=1). After the release procedure, all patients remained continent, but one patient's urinary retention issues were not resolved, and she subsequently underwent a tape-cutting. Both of the patients who underwent the cutting procedure then developed recurrent stress urinary incontinence. The tape-shortening technique was conducted with nine patients. Seven of these patients recovered their continence, and no one patient experienced any urinary retention or other voiding difficulties. Two patients reported only minimal stress leakage and elected to undergo no further interventions. Our findings suggest that tension plays a substantial role in tension-free mid-urethral sling procedures.

A prospective analysis of the need for urinary catheterisation in the first 24 h post-primary arthroplasty

Urinary retention following total hip and knee arthroplasty is a common problem, frequently requiring catheterisation in the immediate post-operative period. The direct relationship between urinary tract instrumentation and deep sepsis in total hip replacements is well documented. This prospective study analysed 164 male patients who underwent primary arthroplasty between September 2004 and March 2005 inclusive. Upon admission and prior to surgery, all patients answered an eight-point urinary symptom questionnaire and were tested on their ability to micturate while supine. Thirty-three patients required urinary catheterisation, 131 did not. The mean age of the catheterised group was 71.4 years and the non-catheterised group was 63.6 years (P<0.001). There was no difference in blood loss between the two groups. With regards to the symptom questionnaire, the mean score in the catheter group was 4.1 and the non-catheter group was 1.8 (P<0.001). The ability to micturate in a supine position was of no predictive value with 23 patients in the catheter group able to do so. These results show the value of a urinary symptom questionnaire used pre-operatively in predicting those who may require post-operative urinary catheterisation. By appropriate use of this tool, patients with potential for post-operative retention may be identified before surgery.

Performance of the tension free vaginal tape procedure when combined with sacrospinous fixation for apical prolapse

SummaryReports of the tension-free vaginal tape (TVT) procedure performed in combination with reconstructive vaginal surgery have been published, but none of these has looked specifically at the sub-group of TVT in combination with sacrospinous colpopexy. This report describes a series of 15 cases where TVT was performed in combination with sacrospinous colpopexy. There were no major complications. Five patients (33.3%) had postoperative urine retention for more than 1 week. Mild incontinence was reported in five cases at 12 months. We conclude that the results of TVT in treating stress incontinence when combined with sacrospinous colpopexy are comparable with TVT alone. Patients should be warned of a higher rate of short-term urinary retention of up to 6 months, while the long-term urinary retention rate is comparable with the TVT procedure alone.

Postoperative urinary retention in general surgical patients.

A prospective study has been performed to measure the incidence of postoperative urinary retention in 280 general surgical patients. Eighteen patients (6 per cent) were catheterized after a range of operations under general anaesthesia. There was no statistical difference in the retention rate between men and women. Increasing age did not predispose to retention of urine. Of 72 patients who had either herniorrhaphy, haemorrhoidectomy or testicular operations, only 1 was catheterized, whereas 16 (23 per cent) of 70 patients undergoing laparotomy were catheterized. Most of these laparotomy patients had upper abdominal procedures carried out. Those having lower abdominal operations were usually catheterized pre-operatively and were excluded from the study. There was a significantly higher incidence of retention among patients who had long anaesthetics (greater than 60 min). There was also a significantly higher incidence of retention among those who were ventilated, relaxed and reversed by atropine and neostigmine. Of those 193 patients who had opiate analgesia, 15 (8 per cent) developed retention of urine, compared with 3 (3 per cent) of the 87 patients who had non-opiate analgesia. There was a significantly higher retention rate among the patients who had opiate analgesia by intravenous infusion compared with those who had opiates by intramuscular bolus injection; 7 patients had painful and 11 had painless retention. This study suggests that postoperative retention of urine is a result more commonly of diminished awareness of bladder sensation, than of factors such as anxiety or local pain.

Highly selective vagotomy and drainage for duodenal ulcer stenosis.

Abstract Thirteen cases of duodenal ulcer complicated by stenosis have been subjected to highly selective vagotomy and a gastro-enterostomy, the gastric stoma of which was situated on the greater curvature in order not to interfere with the antral motility. There was no radiological or clinical evidence of postoperative gastric retention.

Current concepts of percutaneous abscess drainage in postoperative retention.

In recent years, percutaneous abscess drainage (PAD) of intraabdominal abscesses has become an important tool with regard to the treatment of intraabdominal sepsis. The aim of this study is to assess the value of PAD in the treatment of postoperative retentions. Between 1995 and 1999, the postoperative course of 3346 patients undergoing major abdominal surgery was analyzed. Mortality, morbidity, and comparison of different locations of intraabdominal abscesses were assessed. PAD was considered successful when the patient improved clinically within 24 hours, a decrease in the size of the abscess formation was noted, and complete recovery without further surgical intervention occurred. Out of 3346 operated patients, 174 (5.2%) were diagnosed as having an intraabdominal abscess formation and were treated by PAD. In 63 patients the abscess developed within the upper quadrants, in 66 patients the abscess developed within the lower quadrants, and in the remaining 45 patients the abscess developed within the retroperitoneal cavity or pelvis. The success rate of PAD was 85.6% with a morbidity rate of 4.6%. The least successful location for PAD was the left upper quadrant. Patients with abscess drainage in the right upper and lower quadrant experienced a high success rate. One patient died due to the PAD procedure. Unsuccessful PAD was closely related to an increase in mortality. In the case of intraabdominal abscess formation after visceral surgery, PAD should be the primary procedure. Attention should be paid to abscess formations in the left upper quadrant because there is an increased likelihood of complications caused by PAD.

THE ROSTI SLING: A NEW, MINIMALLY INVASIVE, TENSION-FREE TECHNIQUE FOR THE SURGICAL TREATMENT OF FEMALE URINARY INCONTINENCE—THE FIRST 217 PATIENTS

We evaluated the outcome of a new, innovative, inexpensive tension-free technique, the Rosti sling (RS), for female urinary incontinence. RS was performed in 217 patients under local (45%), spinal (52%) or general (3%) anesthesia. A 1.5 x 33 cm strip of polypropylene mesh was inserted under the mid urethra from above through small suprapubic stabs down and out through a 1.5 cm midline vaginal incision using the Stamey needle. Of the women 76% had stress urinary incontinence and 24% had mixed incontinence. Patient age was 24 to 90 years (mean 56) and parity was 0 to 6 (mean 2). The diagnosis of incontinence was based on history and physical examinations with a cough stress test. Mean followup was 23 months. Mean operative time was 25 minutes (range 15 to 45) and mean hospital stay was 3 days (range 1 to 12). Perioperative complications were bladder and urethral perforations in 2 and 1 cases, respectively (1.4%), and hematoma in 3 (1.4%). There was postoperative retention with a variable duration in 49 patients (23%), of whom 41 underwent Hegar dilation. Altogether 186 of 215 patients (86.5%) were cured of incontinence. Two patients were lost to followup and 14 (16.3%) had de novo urge incontinence. The cure rates were 87% for stress urinary incontinence and 91% for mixed incontinence. The cure rate in patients treated under local and spinal anesthesia were 82% and 91%, respectively (p = 0.1084). The rates for RS with recurrent vs primary incontinence were 84% vs 87% (p = 0.5800) and for RS with vs without Hegar dilation 80% vs 88% (p = 0.2094). The technique described is simple, safe and inexpensive. The cure rates are comparable to those of tension-free vaginal tape. However, because of the relatively high rate of postoperative voiding difficulties compared to tension-free vaginal tape, this technique can be criticized. To avoid these problems special attention should be focused on applying the mesh without tension and with precision.

Post-operative retention of urine in children

complication of surgical procedures. The possible causes of this problem include the procedure itself, a drugrelated event (for example, following the use of anticholinergics and analgesics), over-distension of the bladder following surgery under general anaesthesia (Jacobsen et al 1997), and the use of spinal or epidural anaesthesia. Although postoperative urinary retention is not uncommon, especially among older men (Tammela et al 1986), the incidence in children is difficult to establish. This article describes an audit that aimed to identify the incidence of this phenomenon.