Treatment of postoperative voiding dysfunction following incontinence surgery

Persistent postoperative voiding dysfunction is a known complication following female stress incontinence surgery. Although many variations on surgical technique exist, the most common cause remains attributable to hypersuspension of the urethra. The diagnosis of postoperative voiding dysfunction in this setting can be challenging due to the lack of standardized criteria and varied clinical presentation. Furthermore, patients can present with a wide spectrum of symptomatology, not merely incomplete bladder emptying or outright retention. The symptoms of urethral hypersuspension can range from purely bladder storage symptoms on one hand (frequency, urgency, or urge incontinence), to the more commonly recognized bladder emptying dysfunction on the other hand (incomplete emptying or frank urinary retention). Although most cases of mild postoperative voiding dysfunction appear to resolve with expectant management, a subset of patients clearly benefit from a sling incision or formal urethrolysis. This leads to prompt improvement or resolution of their postoperative bladder symptoms. The timing of surgery must be determined by the clinician's judgment. However, experience would suggest that postoperative bladder symptoms that persist beyond 4 weeks rarely resolve spontaneously. Within the literature, there has been a paradigm shift toward earlier intervention. Indeed, there are some data to suggest that delayed time to urethrolysis can lead to irreversible bladder dysfunction.