The Evolution of Obstruction Induced Overactive Bladder Symptoms Following Urethrolysis for Female Bladder Outlet Obstruction

Starkman, Jonathan S.; Duffy, John W.; Wolter, Christopher E.; Kaufman, Melissa R.; Scarpero, Harriette M.; Dmochowski, Roger R.

doi:10.1016/j.juro.2007.10.051

Cited by 39 publications

(27 citation statements)

References 20 publications

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“…The study evaluated 40 patients with obstructive urinary symptoms, 36 of whom reported OAB symptomatology at presentation. After urethrolysis, 56 % reported refractory OAB and were continued on antimuscarinics post-operatively, with 8 ultimately undergoing sacral neuromodulation [57,58]. As such, prompt diagnosis of BOO and early intervention is prudent.…”

Section: Bladder Outlet Obstructionmentioning

confidence: 99%

Evaluation and Management of Mid-Urethral Sling Complications

Brown

Cohn

Kaufman

et al. 2016

Curr Bladder Dysfunct Rep

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Currently, a mid-urethral sling is the standard of care for the treatment of female stress urinary incontinence. However, complications can occur that are unique to polypropylene mesh such as mesh exposure, perforation, or contracture. Other complications such as de novo urgency and/or urgency urinary incontinence (UUI), urinary tract infection, and/or urinary obstruction can also occur. The diagnosis of these complications requires a high index of suspicion, and treatment is critical as these complications can be quite morbid. As such, this review will discuss the most recent literature regarding the intraoperative and post-operative evaluation and management of mid-urethral sling complications.

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Section: Bladder Outlet Obstructionmentioning

confidence: 99%

Evaluation and Management of Mid-Urethral Sling Complications

Brown

Cohn

Kaufman

et al. 2016

Curr Bladder Dysfunct Rep

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“…Compared with obstructive symptoms such as hesitancy, straining, and poor force of stream, overactive bladder symptoms caused by iatrogenically induced BOO following anti-incontinence surgery are less likely to improve despite a technically successful operation. In one series, voiding symptoms resolved in 82 % of obstructed patients following urethrolysis while OAB (storage) symptoms resolved in only 35 % [ 37 ]. In this series, increased time to intervention was not correlated with persistent detrusor dysfunction.…”

Section: Postoperative Complications Voiding Dysfunction and Urinary mentioning

confidence: 62%

Female Stress Urinary Incontinence Surgery Complications: Diagnosis, Evaluation, and Management

Gilchrist

2014

Minimally Invasive Therapy for Urinary Incontinence and Pelvic Organ Prolapse

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Stress urinary incontinence (SUI) affects upwards of 40 % of American women [ 1 ]. Over the past several years, surgical treatment of SUI has evolved from mainly transvaginal needle suspensions, anterior vaginal wall plications, and retropubic suspensions to various types of slings, most commonly midurethral polypropylene slings. Sling surgeries for SUI can be classifi ed by composition (autologous fascia, biologic or synthetic nonabsorbable materials), location of the sling (midurethral or beneath the bladder neck), and approach of placement (retropubic or transobturator). A full discussion of all the types of slings and sling complications is beyond the scope of this article but specifi c operations will be discussed where appropriate. The majority of the following discussion concerns midurethral slings via transobturator or retropubic approaches. Surgical treatment of SUI comprises some of the most commonly performed operations in the United States. Thus, it is important to understand how to avoid and, when necessary, diagnose and treat complications related to these surgeries. Prevention of ComplicationsAlthough most complications are treatable and reversible, the optimal scenario is to prevent or minimize potential for adverse outcomes. This process begins in the preoperative period, initiated during the diagnostic evaluation and work-up. When determining the optimal surgical therapy for patients with urinary incontinence, many factors should be considered, including etiology and type of urinary incontinence and/or prolapse, bladder capacity, renal function, sexual function, medical comorbidities, or concurrent abdominal or pelvic pathology requiring surgical correction, prior abdominal and pelvic surgery, and fi nally, a patient's suitability for and willingness to accept the risks of surgery.Standard preoperative evaluation of an individual with stress incontinence should include a focused history and physical, objective demonstration of SUI, an assessment of post-void residual urine volume and urinalysis and culture if warranted [ 2 ]. It is recommended that the incontinence be characterized and symptom impact and patient expectations be assessed. Additional studies may be indicated to evaluate the lower urinary tract, including pad tests and voiding diary, cystoscopy, and imaging. Furthermore, voiding function should be characterized, with noninvasive fl ow and post-void residual measurements, with invasive urodynamics reserved for patients with abnormal fi ndings, mixed incontinence or

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“…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. In other words, relief of the BOO may turn treatment-refractory storage symptoms or UUI into a treatment-responsive condition.…”

Section: Discussionmentioning

confidence: 91%

“…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%

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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The Evolution of Obstruction Induced Overactive Bladder Symptoms Following Urethrolysis for Female Bladder Outlet Obstruction

Cited by 39 publications

References 20 publications

Evaluation and Management of Mid-Urethral Sling Complications

Evaluation and Management of Mid-Urethral Sling Complications

Female Stress Urinary Incontinence Surgery Complications: Diagnosis, Evaluation, and Management

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

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