VOIDING DYSFUNCTION FOLLOWING - INCONTINENCE - SURGERY - DIAGNOSIS AND TREATMENT WITH RETROPUBIC OR VAGINAL URETHROLYSIS

Purpose: A retrospective analysis was done of women undergoing urethro lysis for post-cystourethropexy voiding dysfunction to identify possib le predictors of outcome. Materials and Methods: The charts of 51 sequ ential women who underwent 54 urethrolysis procedures between 1986 and 1996 were reviewed. The most common presenting symptoms were irritati ve in 38 patients, obstructive in 31, de novo urge incontinence in 28 and persistent retention in 12. Onset was immediate after suspension i n 84% of the patients. Median time from last cystourethropexy or sling to urethrolysis was 15 months (range 4 to 268). Initial evaluation co nsisted of multichannel video urodynamics and cystoscopy in all women. The techniques of urethrolysis were retropubic in 35 cases, vaginal i n 15 or infrapubic in 4, with simultaneous repeat suspensions performe d in 63%. Results: A successful outcome with complete resolution of sy mptoms or significant improvement was achieved in 86% (retropubic), 73 % (vaginal) and 25% (infrapubic) of the cases with a median followup o f 10 months. No parameter examined, namely urodynamic variables, numbe r of previous suspensions, time from suspension to urethrolysis or sur gical approach, was a statistically significant predictor of outcome. Conclusions: Urodynamics may not show classic obstructive voiding in w omen who benefit from urethrolysis. Our only absolute selection criter ion for offering urethrolysis is a clear temporal relationship of symp toms to cystourethropexy. Retropubic and vaginal techniques for urethr olysis provide similar results but morbidity is seemingly less with th e vaginal approach. Omental or Martius fat pad interposition may be of benefit.