Jonathan S. Starkman, John Duffy III, Christopher E. Wolter, Melissa R. Kaufman, Harriette M. Scarpero, and Roger R. Dmochowski

Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN, USA

Introduction: Female urethral obstruction following stress incontinence (SUI) surgery may present with a spectrum of LUTS, including both obstructive and OAB symptoms. Following urethrolysis there is usually consistent resolution of obstructive symptoms, while similar improvement in OAB symptoms demonstrates a more variable natural history. We sought to evaluate the prevalence of persistent OAB symptoms in women following urethrolysis for postoperative bladder outlet obstruction (BOO).

Materials and Methods: A retrospective review of our urethrolysis database identified 39 patients who underwent surgery for relief of BOO following SUI surgery. All patients underwent a comprehensive urologic evaluation including history, physical examination, cystoscopy, and fluoro-urodynamic studies. Exclusion criteria included patients with genitourinary erosion, neurogenic bladder dysfunction, and a known history of pre-existing OAB. Clinical, surgical, urodynamic, and postoperative data were collected in all patients. Urethrolysis outcomes were determined by subjective bladder symptoms, as well as objective data, including measured postvoid residual urine, need for continued intermittent catheterization, and continued pharmacotherapy with muscarinic receptor antagonists. All statistical analyses were conducted using a standard statistical software package (Stata 9.0).

Results: Thirty-nine patients were included in the study. The mean age of our cohort was 56 years (32-83) and the length of followup was 11.6 months (3-38). Overall, the average delay from the initial SUI procedure to urethrolysis was 21 months (3-72). Indications for urethrolysis included clinical BOO (n=33) and new onset OAB symptoms (n=34) felt to be secondary to obstruction. Thirty patients presented with both obstructive and OAB symptoms. Obstructive symptoms resolved in 27 (82%) while OAB symptoms resolved completely in only 12 patients (35%) and improved in 4 (12%). Overall, 18 (53%) patients were taking antimuscarinic medications for persistent OAB symptoms and 5 ultimately required sacral neuromodulation. Detrusor overactivity was present in 12/18 (67%) of patients with persistent OAB symptoms compared to 6/16 (38%) patients whose OAB symptoms resolved (p < 0.05). No other clinical or urodynamic parameters were predictive of persistent OAB symptoms, including time delay from SUI surgery to urethrolysis. Recurrent SUI was observed in 4 patients.

Conclusions: Following urethrolysis, OAB symptoms secondary to urethral obstruction did not resolve in up to 50% of patients in our experience, consistent with other reports in the literature. Detrusor overactivity demonstrated on UDS may be useful in predicting who will develop persistent OAB symptoms, despite an effective urethrolysis procedure. This has important implications when counseling patients for urethrolysis to alleviate OAB symptoms.

UroToday.com Coverage of SUFU 2007

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