Survey of voiding dysfunction and urinary retention after anti-incontinence procedures

Objective: To describe trends in the management of prolonged voiding dysfun ction and urinary retention after anti-incontinence procedures. Methods: Physician members of the American Urogynecologic Society were quer ied by means of a two-page questionnaire regarding the management of prolon ged voiding dysfunction and urinary retention after anti-incontinence proce dures. Results: A total of 344 (42%) of 825 questionnaires were completed and retu rned. Of the 344 respondents, 61% identified themselves as urogynecologists , 50% worked in a university-affiliated practice, and 26% had been in pract ice for 11-20 years. Respondents rarely encountered prolonged urinary reten tion after anti-incontinence procedures. Among the respondents, 30% allowed 3-6 months for resumption of spontaneous voiding before performing surgica l revision, and 90% performed multichannel urodynamic studies before surgic al revision. However, 66% performed surgical revision transabdominally when urinary retention occurred after retropubic urethropexy, and 61-81% of res pondents performed surgical revision transvaginally when urinary retention followed needle suspension, pubovaginal sling, or tension-fi-ee vaginal tap e procedures. A total of 90-96% did not perform an anti-incontinence proced ure concomitantly with surgical revision. The majority of respondents repor ted spontaneous voiding in greater than 80% of patients, and recurrent stre ss urinary incontinence in less than 10% of patients after surgical revisio n. Conclusion: Although certain trends in the management of prolonged urinary retention after anti-incontinence procedures were identified, there was no clear consensus on the method of surgical revision used, nor the management of recurrent stress urinary incontinence after surgical revision. Randomiz ed clinical trials are required to determine the optimal management of prol onged urinary retention after anti-incontinence procedures. (Obstet Gynecol 2001;98:1011-7. (C) 2001 by the American College of Obstetricians and Gyne cologists.).