Female Bladder Outlet Obstruction after Anti-Incontinence Surgery

Urinary incontinence is a significant medical problem affecting quality of life in women. Numerous surgical treatment options are available for management of stress urinary incontinence, including urethral bulking agents, pubo-vaginal slings, retropubic bladder neck suspensions, mid-urethral slings, and even artificial urinary sphincters. We will discuss the incidence, etiology, diagnosis, evaluation, and management of outlet obstruction after anti-incontinence surgery in females. Symptoms of bladder outlet obstruction (BOO) after anti-incontinence surgery can have a wide range of symptoms, including straining to void, valsalva voiding, sense of incomplete emptying, weak stream, acute urinary retention, suprapubic fullness or pain in the setting of patients with prior normal voiding is the single most useful diagnostic parameter. Urodynamic diagnosis of obstruction is not always straight forward, but is another helpful clinical tool. Management options for urinary obstruction post anti-incontinence surgery range from conservative to invasive and surgical treatment options include sling loosening, sling incision and excision, as well as urethrolysis. Optimal timeline for surgical intervention is still not well defined, but general guiding principles of management are presented. Comprehensive review of current literature is also performed.