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Repeat urethrolysis after failed urethrolysis for iatrogenic obstruction
Harriette M Scarpero1, Roger R Dmochowski, Victor W Nitti
1Department of Urology, New York University School of Medicine, New York, New York, USA.
The Journal of Urology
|February 11, 2003
Summary
Repeat urethrolysis effectively resolves urinary retention in 92% of patients after failed initial procedures. While it improves lower urinary tract symptoms, complete resolution of urge incontinence is less common, and recurrent stress incontinence rates are similar to primary surgery.
Area of Science:
- Urology
- Female Pelvic Medicine and Reconstructive Surgery
Background:
- Bladder outlet obstruction is a known complication of stress incontinence surgery.
- Urethrolysis is a successful treatment for iatrogenic obstruction, with reported success rates between 65% and 93%.
Purpose of the Study:
- To evaluate the efficacy of repeat urethrolysis in patients with persistent or recurrent iatrogenic bladder outlet obstruction after at least one prior urethrolysis procedure.
Main Methods:
- A retrospective chart review of 24 women who underwent repeat urethrolysis for iatrogenic obstruction.
- Procedures were performed via retropubic or transvaginal routes.
- Outcomes included spontaneous voiding, reduction in post-void residual urine, and resolution of lower urinary tract symptoms, particularly urge incontinence.
Main Results:
- Repeat urethrolysis successfully eliminated urinary retention in 92% of patients (22 of 24).
- Mean post-void residual urine significantly decreased from 334 ml to 44 ml (p <0.001).
- While 12% experienced complete resolution of irritative symptoms and urge incontinence, 69% required medication for improvement.
Conclusions:
- Aggressive repeat urethrolysis is a highly successful option for relieving iatrogenic urinary retention.
- Complete resolution of irritative symptoms and urge incontinence is less probable following repeat procedures.
- The recurrence rate of stress urinary incontinence after repeat urethrolysis is comparable to that observed after primary urethrolysis.