The efficacy of urethrolysis without re-suspension for iatrogenic urethralobstruction

Purpose: Urethral obstruction following surgical correction of stress urina ry incontinence is not uncommon and urethrolysis is typically used to relie ve symptoms. Whether one should resuspend the bladder neck concurrent with urethrolysis is controversial. We evaluate the efficacy of urethrolysis wit hout re-suspension for the treatment of iatrogenic urethral obstruction. Materials and Methods: From April 1994 to January 1998, 31 women 29 to 18 y ears old (mean age 60) underwent transvaginal urethrolysis without concomit ant re-suspension. The incident procedure was transvaginal urethropexy in 1 5 patients (48%), retropubic urethropexy in 5 (16%) and pubovaginal sling i n 11 (36%). The most common presenting complaints were urinary retention, f eeling of incomplete emptying or straining to void in 22 patients (71%) and irritative voiding symptoms in 17 (55%). Mean time from index procedure to urethrolysis was 14 months (range 2 to 36) and mean followup was 7 (range 1 to 27). Results: After urethrolysis 26 of 31 patients (84%) voided well or had sign ificant improvement in symptoms. Of the 26 improved patients 6 had stress i ncontinence. Of these 6 patients 4 responded to periurethral collagen injec tion and are now dry. When individual variables were analyzed, none was fou nd to be predictive of a successful outcome. Conclusions: Transvaginal urethrolysis without concomitant re-suspension is an effective treatment for iatrogenic urethral obstruction. While 19% of p atients may have recurrent incontinence, the majority can be treated with o utpatient collagen injections. Overall 77% of patients voided well without incontinence, 7% voided well but with some incontinence and 16% remained ob structed after urethrolysis.