Postsurgery for Stress Incontinence

The aims of stress incontinence surgery is to increase the outlet resistance of the urethra by either injection of bulking agents into the urethral musculature, by elevating the bladder base by colposuspension or by inserting tapes or slings to support the urethra under circumstances of raised abdominal pressures, thereby preventing leakage. Unfortunately, in some cases, this is too effective and many women undergoing surgery for stress incontinence develop BOO, which their bladder is unable to cope with in the acute setting, consequent to their surgery, and develop AUR.

The majority of these cases are diagnosed at the point of removing the urethral catheter for a trial of voiding after their surgery, but a degree of BOO that is not clinically evident may have potential to progress insidiously, culminating in AUR.

If the patient is unable to void after surgery, a urethral catheter is typically replaced for a further 2-week period to allow any edema and inflammation around a sling or tape to subside, which is sometimes sufficient to restore normal voiding. However, some patients are still unable to void after this and will go into AUR. For this reason, it is part of good practice to ensure any patient undergoing surgery for stress urinary incontinence is counseled on the possible need for CISC pre-operatively, and has the technique demonstrated so that she is able to perform it should the need arise. Consequently, most patients presenting in AUR after this sort of surgery should be able to perform CISC.

Occasionally, tapes and slings can cause problems related to fibrosis and scarring around the tape or sling. This can in turn cause BOO and ultimately AUR, but the management should initially be the same. In the long-term, the patient may need her sling or tape incised to relieve obstructed voiding.

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