Robotic-assisted urethrolysis for urethral obstruction after retropubic bladder neck suspension-a case series report

Urethral/bladder outlet obstruction (BOO) is a recognized complication after most surgical procedures for stress urinary incontinence. The mechanisms involved are thought to be related to an overcorrection of the urethra (by kinking and/or compressing the urethra) or excessive scar formation between the pubis and urethra. The recommended treatment is usually surgical that aims to free up the obstructed urethra (urethrolysis). For retropubic bladder neck suspension (BNS), robotic-assisted surgery offers a less invasive alternative to classical abdominal approach. We report methods and results of performing robotic-assisted urethrolysis in patients with urethral obstruction after Burch colposuspension.

Six patients presented with voiding difficulties and urinary irritative symptoms after an abdominal hysterectomy and Burch colposuspension. BOO was diagnosed based on history, presenting symptoms, and urodynamic findings, including the maximum flow rate (Qmax) of ≤12 mL/second and detrusor pressure at maximum flow (PdetQmax) of ≥20 cmH2O. Patients underwent robotic-assisted urethrolysis, which consisted of the usual robotic exposure of the abdominal cavity, access to the space of Retzius, removal of Burch sutures, and hypermobilization of the urethra. The intraoperative and postoperative complications, recovery time, and outcome of the procedure to successfully address the patients' symptoms were reviewed and herein reported.

Postoperatively, five of the six patients had complete resolution of the obstructive and irritative symptoms. All had improvement of the postvoid residual volume with a median of 46.5 mL (range 0-176 mL). Postoperatively, urodynamic studies were repeated in two patients and PdetQmax decreased from 39 cmH2O before surgery to 21 cmH2O after urethrolysis and from 31 to 21 cmH2O, respectively. Qmax increased from 0 to 17 mL/second and from 6 to 10 mL/second, respectively.

Robotic-assisted urethrolysis is a feasible and attractive minimally invasive procedure to treat BOO after retropubic BNS.