Management of urinary retention after trans obturator tape (TOT) procedure.
One center experience.
Vikiela Galica , Elona Toska, Pietro Saldutto, Stefano Masciovecchio, Daniela Biferi, Giuseppe Paradiso Galatioto, Carlo
Vicentini. University of L'Aquila, Urology Departament of "G. Mazzini" Hospital, Teramo.
INTRODUCTION & OBJECTIVES: We reviewed our experience with persistent retention after the TOT procedure and
reported our treatment results.
METHODS: We reviewed the charts of 170 TOT procedures that we have performed from April 2005 till November 2012.
Of these 7 patient (4%) developed urinary retention or symptoms consistent with obstruction including hesitancy,
straining to void, or feeling of incomplete emptying, lasting more than 1 week from the date of procedure. We reviewed
the operative record , noting the operative time, presence of urethral injury, and any reported complication. Initially all
the patients underwent a conservative treatment using α-adrenergic blockers and urethral dilatation. Of the 7 patients
only 5 patients subsequently underwent transvaginal release of the mesh within 12 weeks. We performed a unilateral
incision of the sling.
RESULTS: Seven patients developed urinary retention after TOT. Two patients had a urethral dilatation and were treated
with α-adrenergic blockers for a mean time of 5 days. At the discharge the post-voiding residual urine measured 50 ml
and 60 ml respectively. De novo urgency was reported in 1 patient and it was successfully treated with solifenacin 5mg.
The other 5 patients who underwent a unilateral sling release voided to completion within 6 hours. None of the patients
reported further subjective complaints of outlet obstruction. All the patients who underwent the mesh release were
continent. The mean operative time was about 13 minutes and no urethral injury occurred.
DISCUSSION: Data shows that up to 20% of patients will have new urinary complaints after incontinence surgery. A
properly placed suburethral sling does not produce obstruction as long as excessive tension is avoided. Treatment of
urinary retention can begin conservatively with α- adrenergic blockers, urethral dilatation and clean intermittent
catheterization but the majority of patients will, however require the sling incision. Several surgeons prefers a midline
sling incision and subsequently if the relaxation of urethral support is not adequate unilateral or bilateral incision of the
sling as it enters the endopelvic fascia. In this study only a unilateral incision was performed, choosing when was
possible the side where a higher tension of the sling was evident and also in order to avoid urethral injury. Early relief of
obstruction can be associated with a lower incidence of permanent voiding dysfunction than if treatment for obstruction is
delayed.
CONCLUSIONS: Urinary retention can be a complication after TOT. If no urethral injury occurred during the operative
time a conservative approach may be considered. The release of the mesh by an unilateral incision, in local anesthesia
is a valid alternative with a rapid return to normal voiding. In our experience all the patients remained dry. There is
general agreement that early relief of obstruction is associated with lower incidence of permanent voiding dysfunction.