[Transvestibular urethrolysis]

Bladder outlet obstruction with obstructive and irritative urinary symptoms may be a complication of surgery for female urinary incontinence. In presence of persistent symptoms, the therapy is surgical and usually consists in an accurate urethrolysis. The way of approach is generally transvaginal. In this paper we propose and describe our experience with a transvestibular approach.

18 women who had undergone anti-incontinence surgery (TVT 12 pts, TOT 3 pts, Burch retropubic colposuspension 3 pts) with obstruction and/or irritative symptoms underwent to a transvestibular urethrolysys. Five patients had urinary retention and the rest of patients had post voiding residual urine>100 ml. Using a scalpel blade a circum-meatal incision was performed and the urethra was progressively freed, dissecting just below the os pubis upwards and on the vaginal wall downwards, untethering it under direct vision in order to abtain a complete circular freeing of the urethra. In the end, the urethral meatus is repositioned with circular stiches.

The operation lasts between 20 and 40 minutes. An urethral catheter was left in place for 24-48 hours and no complications were observed. The post-voiding residual urine decreased in all of the cases and the irritative symptoms were reduced.

The transvestibular approach for urethrolysis is safe and effective regardless of the previous anti-incontinence surgery carried out. This procedure has the advantage of working in a relatively unscarred tissue, allows for a complete untethering of the urethra even in the retropubic space and leaves the vaginal wall intact.