Treatment of chronic urinary retention after surgical repair of urinary incontinence by transurethral bladder neck resection.

Objective: To evaluate the efficacy and safety of transurethral resection o f the overcorrected posterior lip of the bladder neck in patients with chro nic urinary retention after repair of incontinence. Material and Methods: Transurethral bladder neck resection was performed in 26 women with a median age of 59 years. Incontinence repair consisted of a Burch procedure in eight cases, a Raz procedure in eight cases a Marshall- Marchetti-Krantz procedure in five cases, an aponeurotic sling in three cas es and a synthetic sling in two cases. The median preoperative maximum urin e flow rate was 11.5 ml/s and the median residual urine was 150 ml. Preoper ative cystourethrography and cystoscopy revealed overcorrection of the blad der neck in each case. Results: With a median follow-up of 39 months, 65.5% of patients were cured (resolution of symptoms, maximum urine flow rate greater than 15 ml/s and residual urine less than 50 ml), 23% were improved and 11.5% were considere d to be failures. No complications or secondary urinary incontinence were o bserved. Patients not cured by this technique were treated by urethrolysis in three cases, Uroflow(R) stent in one case and section of a Raz cervicocy stopexy suture in one case. Conclusion: Transurethral bladder neck resection can be used as first-line treatment for chronic urinary retention after repair of incontinence, as ii is an effective, rapid, minimally invasive technique not associated with a ny morbidity. Urethrolysis can always be performed in the case of failure.