Management of bladder outlet obstruction after stress urinary incontinence surgery in women: Results of a North American Survey among surgeons

Introduction

To gather expert opinion and describe trends in the management of early and prolonged bladder outlet obstruction following stress urinary incontinence surgery.

Methods

Expert physicians and members of the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU), were queried by means of an online survey regarding the management of bladder outlet obstruction following stress urinary incontinence surgery.

Results

Sixty surgeons answered the questionnaire (9 %). Most responders performed >20 sling procedures per year, and 15 % of them were autologous fascial pubovaginal slings. The estimated prevalence of complete postoperative urinary retention was 3 %. The prevalence of post-void residual volume ≥200 ml, was estimated around 8 %. Of those presenting with post-void residual ≥200 ml, 35 % were symptomatic. For a inability to void 48 h after synthetic mid-urethral sling insertion, most responders would observe for a week before planning an incision of the sling. In the case of post-void residual ≥200 ml, the trend of the majority would be observation. In patient in inability to void 48 h following autologous fascial pubovaginal sling procedure, most participants would offer observation, as well as if the patient presented with post-void residual ≥200 ml.

Conclusions

According to expert opinion, although we could highlight some trends in the management of bladder outlet obstruction associated with urinary retention following the surgical management of female stress urinary incontinence, particularly with regards to observation, there was no consensus on the management in terms of method or timing of surgical revision.