Evaluation and management of urinary retention after a suburethral sling procedure in women

The Impact of Body Contouring Procedures on Urologic Outcomes in Massive Weight Loss Patients

BACKGROUND

Post-massive weight loss body contouring is a growing area of plastic surgery. Studies have shown preexisting urinary incontinence amelioration in patients undergoing abdominal body-contouring procedures. These studies are small, focus on cosmetic abdominoplasties, and lack use of standardized surveys. The purpose of this study was to evaluate urinary incontinence endpoints in massive weight loss patients undergoing body-contouring procedures.

METHODS

A retrospective review was conducted over a 6-year period. Patients excluded had previous body-contouring procedures or previously treated urinary incontinence. Participants completed validated surveys to catalogue preoperative and postoperative urinary habits. Patients were then subdivided based on presence of preoperative incontinence. Outcomes were compared within and between cohorts using the t test and chi-square test.

RESULTS

A total of 102 patients completed the survey. Of those, 44 had preoperative urinary incontinence. Patients with incontinence were found to be significantly older than those who did not. Postoperatively, patients with preoperative incontinence had significant decreases in incidence and severity of symptoms (p < 0.01, respectively), and significantly improved their quality of life (p < 0.02). Over 20 percent noted symptom resolution, and 67 percent were mostly or completely satisfied with the outcome.

CONCLUSIONS

This study is the first to document amelioration of urinary incontinence symptoms in massive weight loss patients undergoing body-contouring procedures. It adds to the literature suggesting that abdominoplasties in select patients may improve incontinence symptoms. Future work will focus on evaluating the mechanism of this outcome and documenting improvement in an objective, prospective manner.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

[Causes, characteristics and mid-term course of acute urinary retention in women referred to a urodynamics unit]

OBJECTIVES

Acute urinary retention (AUR) is uncommon in women and can be related to different conditions. Only some patients are referred to the urodynamics units for a more extensive study. We intend to describe the charcteristics and causes of AUR in women referred to our unit and to analyze their middle term evolution.

MATERIAL AND METHODS

We performed a descriptive retrospective study (January 1982-December 2006), including the women referred to our Uro-Neurology and Urodynamics Unit after suffering an AUR. Medical charts were reviewed with special emphasis on medical history, physical examination, and also complete urodynamics study during the AUR event and after its resolution.

RESULTS

A total of 202 women were included, median age of 57 years (12-87 years). Prior to the AUR, 59 women (28.7%) reported voiding symptoms. The urodynamics findings were: 65 (32.2%) detrusor hypocontractility; 64 (31.7%) normal study; 37 (18.3%) detrusor acontractility; 21 (10.4%) bladder outlet obstruction; 15 (7.4%) poor pelvic floor relaxation. The causes of the AUR were: 53 neurological (26.2%); 46 unknown (22.8%); 19 gynecological (9.4%); 22 diabetes mellitus (10.9%); 16 urological (7.9%). Renal insufficiency was observed in 14 patients (6.9%). After the AUR 106 women (52.4%) needed some kind of prolonged treatment.

CONCLUSIONS

In our experience, AUR in the female is mainly related to underlying neurologic/urogynecologic disease, even though the etiology could not be known in a significant percentage of patients. Half of the patients recovered completely and did not require any treatment.

The evolution of surgical treatment for female stress urinary incontinence: era of mid-urethral slings

Based on the integral theory, tension-free placement of a mid-urethral sling (MUS) for female stress urinary incontinence (SUI) has gained substantial popularity owing to the ease of the procedure and its effectiveness. Published series with long-term follow-up show continence rates after the MUS procedure ranging from 70% to 80%. Complication rates after MUS procedures are usually low. This review aimed to describe the historical change and the current use of the MUS. We discuss the efficacy and complications of various MUS procedures and the current strategies for managing failed slings.

A minimally invasive technique for relaxing overtentioned midurethral slings

Midurethral slings for stress urinary incontinence are effective surgical treatment with substantial rate of postoperative urinary retention. Different operative procedures ranging from urethrolysis to midline sling incision have been described to correct these cases. In this letter, we describe a minimally invasive technique for loosening overtensioned midurethral slings.