Recognition and treatment of bladder outlet obstruction after sling surgery

At the University of Pittsburgh School of Medicine, our experience with urethrolysis over the past several years offered a unique opportunity to assess outcomes after delayed time to urethrolysis. We observed a highly suggestive association between prolonged time to urethrolysis and a greater likelihood of persistent bladder dysfunction. If this observation is corroborated by other studies, it would be prudent to lower our threshold of clinical suspicion to detect bladder outlet obstruction. Videourodynamics testing can be invaluable for making the distinction between outlet obstruction versus de novo urge incontinence. Here, we briefly review the literature on urethrolysis and present the urethrolysis technique utilized at our institution. The article concludes with several challenging and controversial clinical judgment questions asked ofDr Leng by Dr Chancellor.