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Commented Abstracts

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  • Rate of recurrent stress urinary incontinence after retropubic urethrolysis.
    Petrou SP, Young PR.
    J Urol 2002 Feb;167(2 Pt 1):613-5


PURPOSE: We determined the rate of recurrent female stress urinary incontinence after retropubic urethrolysis without a concomitant anti-incontinence procedure.

MATERIALS AND METHODS: We reviewed the charts of all women who underwent urethrolysis at our institution for urethral obstruction due to an anti-incontinence procedure. The study was limited to patients who underwent retropubic urethrolysis without a synchronous anti-incontinence operation or interposition flap inlay for obstruction associated with a sub urethral sling. Variables reviewed included the  history of urethrolysis, success of retropubic urethrolysis and incidence of urinary incontinence after the operation.

RESULTS: A total of 12 patients met our study criteria, of whom 1 had stress urinary incontinence before retropubic urethrolysis. Of the 12 patients 10 achieved a successful result after urethrolysis and 2 achieved improvement but not success secondary to urinary urge incontinence. Protective padding was needed postoperatively for urinary incontinence in 5 of the 12 cases, including 3 (25%) and 2 (17%) due to stress and urgency incontinence, respectively. New onset stress urinary incontinence developed postoperatively in 2 of the 11patients (18%) who did not have stress urinary incontinence before retropubic urethrolysis. A history of failed urethrolysis did not significantly increase the urinary incontinence rate postoperatively.

CONCLUSIONS: Although retropubic urethrolysis has a high potential success rate for resolving urethral obstruction, it may cause a higher incidence of recurrent stress urinary incontinence than transvaginal approaches. There is no clear need for a synchronous anti-incontinence procedure at the time of retropubic urethrolysis.

                                       EDITORIAL COMMENT

The pubovaginal slings have gotten a wide acceptance as a therapeutical method in the treatment of stress urinary incontinence. Initially reserved for patients that are carriers of intrinsic sphincterian dysfunction and with a grave urinary incontinence, now a days they are also used for patients with “anatomic” incontinence. Despite the high success rates, the pubovaginal sling morbidity is not negligible. The most feared of complications is obstruction, which might be light and determine irritative symptoms or, in the gravest cases lead to urinary retention and the need of and intermittent catheterism. When urethrolysis is proposed the patient’s main worry is to return to the stage before surgery. The procedures with vaginal approach lead to success rates which vary from 50 to 80% and the rate of getting incontinence again vary from 0 to 20% of the patients, even though in most trials it is around 5%. By retropubic way the success rates of urethrolysis are slightly higher and reach 84% of the cases. 
In this trial, with retropubic approach, the authors observed a SUI development in only two of the eleven patients (18%). Even though the casuistic is small there does not seem a clear need of a synchronous anti-incontinence procedure with urethrolysis.

Aparecido Donizeti Agostinho.

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