Can urethrolysis resolve outlet obstruction related symptoms after Burch colposuspension for stress urinary incontinence?

Giannis, G; Bousouni, E.; Mueller, Michael D.; Imboden, Sara; Mohr, Stefan; Raio, Luigi; Kühn, Annette

doi:10.1016/j.ejogrb.2015.09.033

Cited by 5 publications

(6 citation statements)

References 24 publications

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“…Case series show improved voiding and lower PVR volumes, improvement or resolution of symptoms and QoL, and improvement of urodynamic parameters after urethrolysis treatment [82][83][84]. De novo SUI was reported in 39% of cases in one study [84]. A greater delay in performing urethrolysis was associated with persistent bladder symptoms [85].…”

Section: 2237mentioning

confidence: 95%

European Association of Urology Guidelines on the Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 2: Underactive Bladder, Bladder Outlet Obstruction, and Nocturia

et al. 2022

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Section: 2237mentioning

confidence: 95%

European Association of Urology Guidelines on the Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 2: Underactive Bladder, Bladder Outlet Obstruction, and Nocturia

et al. 2022

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“…Overactive bladder (OAB) symptoms are common for several months after a successful urethrolysis. Several prior studies have demonstrated this risk; storage symptoms are unfortunately relatively unlikely to resolve following urethrolysis for iatrogenic BOO, particularly in repeat cases . In a retrospective series of 40 patients who underwent urethrolysis, Starkman et al reported that OAB may remain refractory in 50% of patients or more, and this had a negative impact on quality of life and the impression of improvement after surgery in their study .…”

Section: Discussionmentioning

confidence: 92%

“…Ten of 11 patients had evaluable pressure flow studies. Median preoperative intubated peak flow rate and maximum detrusor pressure during voiding were 7.5 cc/s (range [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], and 16 cm Among the three patients who complained of SUI preoperatively, SUI resolved in two patients and one patient complained of persistent SUI following SMUM, but this occurred rarely and did not require the use of any protection. One patient (9%) developed recurrent SUI and is planned to undergo periurethral bulking injection.…”

Section: Resultsmentioning

confidence: 99%

“…Several prior studies have demonstrated this risk; storage symptoms are unfortunately relatively unlikely to resolve following urethrolysis for iatrogenic BOO, particularly in repeat cases. 15,19 In a retrospective series of 40 patients who underwent urethrolysis, Starkman et al reported that OAB may remain refractory in 50% of patients or more, and this had a negative impact on quality of life and the impression of improvement after surgery in their study. 20 In our experience, in patients with refractory OAB symptoms prior to surgery, if BOO has resolved following surgery, persistent OAB symptoms typically respond to cholinolytic therapy or onabotulinum toxin-A injection.…”

Section: Discussionmentioning

confidence: 99%

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Suprameatal urethrolysis with Martius flap for refractory bladder outflow obstruction following stress incontinence surgery in females

Oliver

Raz

2017

Neurourology and Urodynamics

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Aims: To present our technique of suprameatal urethrolysis with Martius flap (SMUM) and outcomes of this procedure for refractory female bladder outflow obstruction (BOO). Methods: A retrospective chart review was performed to identify female patients who underwent SMUM between January 2010 and August 2016 after failed transvaginal urethrolysis (TVU) for BOO due to prior stress urinary incontinence (SUI) surgery. The primary outcome measure was surgical success defined as patient ability to void volitionally without need for catheterization or additional surgery for BOO. Secondary outcomes assessed included perioperative outcomes, intraoperative and 30-day complications, change in post-void residual volume (PVR), resolution of urge urinary incontinence (UUI), incidence of recurrent SUI, and treatment for any urinary incontinence. Results: Eleven patients were identified. After a median follow-up of 10.8 months (range 3.1-20.1), the procedure was successful in nine patients (82%). Postoperative median PVR was 29 cc (range 0-425) and median change in PVR was a 280 cc (range 29-1050) decrease (P < 0.01). Among the seven patients who required catheterization preoperatively, five patients (71%) recovered volitional voiding. Two patients (18%) continued to require indwelling or intermittent catheterization and underwent additional surgery for BOO. SUI recurred in one patient (9%). UUI persisted in all four patients who reported this preoperatively. Conclusions: SMUM is successful in improving or relieving refractory BOO in this challenging patient population. After TVU, we believe that Martius flap interposition is critical to preventing recurrent fixation of the urethra to the pubic bones and thus achieving improved voiding. K E Y W O R D Spostoperative complications, stress/surgery, urinary retention/surgery, urethra/surgery, urinary incontinence, urinary retention/etiology Abbreviations: BOO, bladder outflow obstruction; LUTS, lower urinary tract symptoms; MUS, mid urethral sling; OAB, overactive bladder; PVR, postvoid residual volume; SMUM, suprameatal urethrolysis with Martius flap interposition; SUI, stress urinary incontinence; TVU, transvaginal urethrolysis; UDS, urodynamics; UTI, urinary tract infection; UUI, urge urinary incontinence; VUDS, video urodynamics.

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“…22 A larger cohort study found significant improvement in quality of life after urethrolysis as well as improvement in PVR. 23 Another study, reported new overactive bladder symptoms in 21% of the patients who underwent urethrolysis. 24 Although a different endpoint than our study, taken collectively these With regards to the finding that UPP length negatively correlated (p < 0.05) with time since AI procedure (r=-0.70); while the IQR for length is relatively short, at 20-27 mm, further studies are needed to draw a direct conclusion with respect to UPP length and duration since AI procedure.…”

confidence: 98%

Urodynamic and urethral pressure profilometry findings in women with voiding phase dysfunction treated with surgical urethrolysis

Dobberfuhl,

Comiter,

Deb

2023

CUAJ

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Introduction: Long-term urodynamic (UDS) and urethral pressure profilometry (UPP) parameters in women with voiding phase dysfunction following an anti-incontinence (AI) procedure have been poorly characterized. We report our 10-year UDS findings in women with voiding phase dysfunction after AI procedure, who underwent urethrolysis. Methods: We identified sequential records containing urethrolysis CPT codes over a 10-year period. Records of women with preoperative UDS were reviewed for demographics, UDS tracing, and outcomes following urethrolysis. Results: Twenty-five women (mean age 60 years) had voiding phase dysfunction and underwent urethrolysis at a mean of 47 months (interquartile range [IQR] 12–61) after AI procedure. Preoperatively, six (24%) women required intermittent catheterization. Free uroflowmetry revealed a mean: maximum peak flow (Qmax) 9.6 ml/s (IQR 7.0–11.0), voided volume 137 ml (IQR 81–169), and postvoid residual 167 ml (IQR 43–288). UDS revealed a mean: UPP length 24 mm (IQR 20–27), UPP closure pressure 78 cmH2O (IQR 59–103), Pdet@Qmax 31 cmH2O (IQR 19–43), Qmax 7.9 ml/s (IQR 5.0–12.0), bladder outlet obstruction index 15 (IQR 0–34), and bladder contractility index 71 (IQR 60–81). UPP length was significantly associated (Pearson correlation, p<0.05) with: bladder outlet obstruction index (r=0.80), Pdet@Qmax (r=0.75), and time since AI procedure (r=-0.70). UPP closure pressure was significantly associated with age (r=-0.64), volume of first (r=-0.64) and strong (r=-0.78) desire, and capacity (r=-0.71). Following urethrolysis, spontaneous voiding was achieved in 23 (92%) women at followup (mean 308 days). Conclusions: UPP may help characterize outlet parameters in women with voiding phase dysfunction following an AI procedure, who ultimately undergo urethrolysis.

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Can urethrolysis resolve outlet obstruction related symptoms after Burch colposuspension for stress urinary incontinence?

Cited by 5 publications

References 24 publications

European Association of Urology Guidelines on the Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 2: Underactive Bladder, Bladder Outlet Obstruction, and Nocturia

European Association of Urology Guidelines on the Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 2: Underactive Bladder, Bladder Outlet Obstruction, and Nocturia

Suprameatal urethrolysis with Martius flap for refractory bladder outflow obstruction following stress incontinence surgery in females

Urodynamic and urethral pressure profilometry findings in women with voiding phase dysfunction treated with surgical urethrolysis

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