The efficacy of urethrolysis without re-suspension for iatrogenic urethral obstruction

Urethral obstruction following surgical correction of stress urinary incontinence is not uncommon and urethrolysis is typically used to relieve symptoms. Whether one should resuspend the bladder neck concurrent with urethrolysis is controversial. We evaluate the efficacy of urethrolysis without re-suspension for the treatment of iatrogenic urethral obstruction.

From April 1994 to January 1998, 31 women 29 to 78 years old (mean age 60) underwent transvaginal urethrolysis without concomitant re-suspension. The incident procedure was transvaginal urethropexy in 15 patients (48%), retropubic urethropexy in 5 (16%) and pubovaginal sling in 11 (36%). The most common presenting complaints were urinary retention, feeling of incomplete emptying or straining to void in 22 patients (71%) and irritative voiding symptoms in 17 (55%). Mean time from index procedure to urethrolysis was 14 months (range 2 to 36) and mean followup was 7 (range 1 to 27).

After urethrolysis 26 of 31 patients (84%) voided well or had significant improvement in symptoms. Of the 26 improved patients 6 had stress incontinence. Of these 6 patients 4 responded to periurethral collagen injection and are now dry. When individual variables were analyzed, none was found to be predictive of a successful outcome.

Transvaginal urethrolysis without concomitant re-suspension is an effective treatment for iatrogenic urethral obstruction. While 19% of patients may have recurrent incontinence, the majority can be treated with outpatient collagen injections. Overall 77% of patients voided well without incontinence, 7% voided well but with some incontinence and 16% remained obstructed after urethrolysis.