Skip to main content
SpringerLink
Log in

Vaginal Approach to Postsurgical Bladder Outlet Obstruction

  • Chapter
Book cover Vaginal Surgery for Incontinence and Prolapse

  • 1085 Accesses

Abstract

Bladder outlet obstruction resulting in voiding dysfunction following anti-incontinence procedures can be a disappointing outcome for both patient and surgeon. When stress incontinence is replaced by lower urinary tract symptoms (LUTS) such as frequency, urgency or urge incontinence, difficulty voiding, or urinary retention, the patient may have more severe complaints than at initial presentation. It is a challenging task for the clinician to decide what if any action to take and when to take it and by what approach. Several considerations are the type of anti-incontinence procedure, postoperative physical findings, the patient’s degree of bother, and any addition testing that may be performed. Recent work has focused on clarifying the etiology and incidence of this condition, as well as providing new definitions on bladder-outlet obstruction in women. In addition, effective, less invasive ways of treating this condition have been described. The prevailing doctrine is not to make a bad situation worse and to find the simplest solution that produces the least anxiety for the patient. The vaginal approach to sling incision and urethrolysis is appealing for this reason. This chapter discusses the incidence and etiology of postsurgical obstruction, the diagnostic evaluation, and the current management and treatment for this condition, with specific emphasis on the vaginal approach.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Horbach NS. Suburethral sling procedures. In: Ostergard DE, Bent AE, eds. Urogynecology and Urodynamics Theory and Practice, 3rd ed. Baltimore: Williams & Wilkins, 1991:413–421.

    Google Scholar 

  2. Spencer JR, O’Conor VJ Jr, Schaeffer AJ. Comparison of endoscopic suspension of the vesical neck with suprapubic vesicourethropexy for treatment of stress urinary incontinence. J Urol 1987;137:411–415.

    PubMed  CAS  Google Scholar 

  3. Mundy AR. A trial comparing the Stamey bladder neck suspension with colposuspension for the treatment of stress incontinence. Br J Urol 1983;55:687–690.

    PubMed  CAS  Google Scholar 

  4. McDuffie RW, Litin RB, Blundon KE. Urethrovesical suspension (Marshall-Marchetti-Krantz). Experience with 204 cases. Am J Surg 1981;141:297–298.

    Article  PubMed  Google Scholar 

  5. Cardoza LD, Stanton SL, Williams JE. Detrusor instability following surgery for genuine stress incontinence. Br J Urol 1979;51:204–210.

    Article  Google Scholar 

  6. Leach GE, Dmochowski RR, Appell RA, et al. Female stress urinary incontinence clinical guidelines panel report on surgical management of female stress urinary incontinence. J Urol 1997;158:875–880.

    Article  PubMed  CAS  Google Scholar 

  7. Morgan TO, Westney OL, McGuire EJ. Pubovaginal sling: 4-year outcome and quality of life assessment. J Urol 2000;163:1845–1848.

    Article  PubMed  Google Scholar 

  8. Chaikin DC, Rosenthal J, Blaivas JG. Pubovaginal fascial sling for all types of stress urinary incontinence: long-term analysis. J Urol 1998;160:1312–1316.

    Article  PubMed  CAS  Google Scholar 

  9. Klutke C, Siegel S, Carlin B, Paszkiewicz E, Kirkemo A, Klutke J. Urinary retention after tension-free vaginal tape procedure: incidence and treatment. Urology 2001;5:697–701.

    Article  Google Scholar 

  10. Rardin CR, Rosenblatt PL, Kohli N, Miklos JR, Heit M, Lucente VR. Release of tension-free vaginal tape for treatment of refractory postoperative voiding dysfunction. Obstet Gynecol 2002;100:898–902.

    Article  PubMed  CAS  Google Scholar 

  11. Karram MM, Segal JL, Vasallo BJ, Kleeman SD. Complication and untoward effects of the tension-free vaginal tape procedure. Obstet Gynecol 2003;101:929–932.

    Article  PubMed  Google Scholar 

  12. Croak AJ, Schulte V, Peron S, Klingele C, Gebhart J, Lee R. Transvaginal tape lysis for urinary obstruction after tension-free vaginal tape placement. J Urol 2003;169:2238–2241.

    Article  PubMed  Google Scholar 

  13. Dunn JS, Bent AE, Ellerkman RM, Nihira MA, Melick CF. Voiding dysfunction after surgery for stress incontinence: literature and survey results. Int Urogynecol J 2004;15:25–31.

    Article  Google Scholar 

  14. Klutke JJ, Klutke CG, Bergman G, Elia G. Urodynamic changes in voiding after anti-incontinence surgery: an insight into the mechanism of cure. Urology 1999;54:1003–1007.

    Article  PubMed  CAS  Google Scholar 

  15. Kuo HC. Comparison of video urodynamic results after the pubovaginal sling procedure using rectus fascia and polypropylene mesh for stress urinary incontinence. J Urol 2001;165:163–168.

    Article  PubMed  CAS  Google Scholar 

  16. Delorme E, Droupy S, de Tayrac R, Delmas V. Transobturator tape (Uratape): a new minimally-invasive procedure for stress incontinence. Eur Urol 2004;45:203–207.

    Article  PubMed  Google Scholar 

  17. Leng WW, Davies BJ, Tarin T, et al. Delayed treatment of bladder outlet obstruction after sling surgery: association with irreversible bladder dysfunction. J Urol 2004;172:1379–1381.

    Article  PubMed  Google Scholar 

  18. Carr LK, Webster GD. Voiding dysfunction following incontinence surgery: diagnosis and treatment with retropubic or vaginal urethrolysis. J Urol 1997;157:821–823.

    Article  PubMed  CAS  Google Scholar 

  19. Chassagne S, Bernier PA, Haab F, Roehborn CG, Reisch JS, Zimmern PE. Proposed cutoff values to define bladder outlet obstruction in women. Urology 1998;51:409–411.

    Article  Google Scholar 

  20. Lemack GE, Zimmern PE. Pressure flow analysis may aid in identifying women with outflow obstruction. J Urol 2000;163:1823–1828.

    Article  PubMed  CAS  Google Scholar 

  21. Nitti VW, Tu LM, Gitlin J. Diagnosing bladder outlet obstruction in women. J Urol 1999;161:1535–1540.

    Article  PubMed  CAS  Google Scholar 

  22. Blaivas JG, Groutz A. Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurol Urodyn 2000;19:553–564.

    Article  CAS  Google Scholar 

  23. Foster HE, McGuire EJ. Management of urethral obstruction with transvaginal urethrolysis. J Urol 1993;150:1448–1451.

    PubMed  CAS  Google Scholar 

  24. Nitti VW, Raz S. Obstruction following antiincontinence procedures: diagnosis and treatment with transvaginal urethrolysis. J Urol 1994;152:93–98.

    PubMed  CAS  Google Scholar 

  25. Leach GE, Raz S. Modified Pereyra bladder neck suspension after previously failed anti-incontinence surgery. Urology 1984;23:359–362.

    Article  PubMed  CAS  Google Scholar 

  26. Carey JM, Chon JK, Leach GE. Urethrolysis with Martius labial fat pad graft for iatrogenic bladder outlet obstruction. Urology 2003;61(suppl 4a):21–25.

    Article  PubMed  Google Scholar 

  27. Goldman HB, Rackley RR, Appell RA. The efficacy of urethrolysis without re-suspension for iatrogenic urethral obstruction. J Urol 1999;161:196–198.

    Article  PubMed  CAS  Google Scholar 

  28. Cross CA, Cespedes D, English SF, McGuire EJ. Transvaginal urethrolysis for urethral obstruction after anti-incontinence surgery. J Urol 1998;159:1199–1201.

    Article  PubMed  CAS  Google Scholar 

  29. Petrou SP, Brown JA, Blaivas JG. Suprameatal transvaginal urethrolysis. J Urol 1999;161:1269–1271.

    Article  Google Scholar 

  30. Ghoniem GM, Elgmasy AN. Simplified surgical approach to bladder outlet obstruction following pubovaginal sling. J Urol 1995;154:181–183.

    Article  PubMed  CAS  Google Scholar 

  31. Kusuda L. Simple release of pubovaginal sling. Urology 2001;57:357–359.

    Article  Google Scholar 

  32. Amundsen CL, Guralnick ML, Webster GD. Variations in strategy for the treatment of urethral obstruction after a pubovaginal sling procedure. J Urol 2000;164:434–437.

    Article  PubMed  CAS  Google Scholar 

  33. Nitti VW, Carlson KV, Blaivas JG, et al. Pubovaginal sling lysis by midline incision. Urology 2002;59:47–52.

    Article  PubMed  Google Scholar 

  34. Goldman HB. Simple sling incision for the treatment of iatrogenic urethral obstruction. Urology 2003;62:714–718.

    Article  PubMed  Google Scholar 

  35. Scarpero HM, Dmochowski RR, Nitti VW. Repeat urethrolysis following failed urethrolysis for iatrogenic obstruction. J Urol 2002;167:1013–1016.

    Google Scholar 

  36. Zimmern PE, Hadley HR, Leach GE, Raz S. Female urethral obstruction after Marshall-Marchetti-Krantz operation. J Urol 1987;138:517–520.

    PubMed  CAS  Google Scholar 

  37. Webster GD, Kreder KJ. Voiding dysfunction following cystourethropexy: its evaluation and management. J Urol 1990;144:670–673.

    PubMed  CAS  Google Scholar 

  38. Petrou SP, Young PR. Rate of recurrent stress urinary incontinence after retropubic urethrolysis. J Urol 2002;167:613–615.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, New York University School of Medicine, New York, NY, USA

    Victor W. Nitti MD

  2. Department of Urology, Mount Sinai School of Medicine, New York, NY, USA

    Nicole Fleischmann MD

Authors
  1. Victor W. Nitti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicole Fleischmann MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Urology, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA

    Philippe E. Zimmern MD, FACS (Professor of Urology, Jane and John Justin Distinguished Chair in Urology In honor of Claus Roehrborn, MD) (Professor of Urology, Jane and John Justin Distinguished Chair in Urology In honor of Claus Roehrborn, MD)

  2. University of Utah School of Medicine, Salt Lake City, UT, USA

    Peggy A. Norton MD, FACOG (Professor of Obstetrics and Gynecology, Chief of Urogynecology and Reconstructive Pelvic Surgery) (Professor of Obstetrics and Gynecology, Chief of Urogynecology and Reconstructive Pelvic Surgery)

  3. Urology Department, Tenon Hospital, Paris, France

    François Haab MD (Professor of Urology) (Professor of Urology)

  4. Department of Urology, The Royal Hallamshire Hospital, Sheffield, UK

    Christopher C. R. Chapple BSc, MD, FRCS (Urol), FEBU (Consultant Urological Surgeon) (Consultant Urological Surgeon)

Rights and permissions

Reprints and permissions

Copyright information

© 2006 Springer-Verlag London Limited

About this chapter

Cite this chapter

Nitti, V.W., Fleischmann, N. (2006). Vaginal Approach to Postsurgical Bladder Outlet Obstruction. In: Zimmern, P.E., Norton, P.A., Haab, F., Chapple, C.C.R. (eds) Vaginal Surgery for Incontinence and Prolapse. Springer, London. https://doi.org/10.1007/978-1-84628-346-8_16

Download citation

  • DOI: https://doi.org/10.1007/978-1-84628-346-8_16

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-85233-912-8

  • Online ISBN: 978-1-84628-346-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation