Management of urethral obstruction with transvaginal urethrolysis.

Transvaginal urethrolysis was performed in 48 patients with urethral obstruction following 1 or more urethral suspension procedures. A needle suspension procedure had been performed in 19 patients (40%), retropubic urethropexy in 17 (35%) and pubovaginal sling in 10 (21%). A good response as indicated by normal voiding with minimal or no irritative symptoms was achieved in 33 patients (65%). The most common presenting complaints were irritative voiding symptoms (71%) and urinary retention (60%). Fluoroscopic urodynamic evaluation frequently demonstrated urethral hypersuspension, a cystocele and/or elevated voiding pressures. No patient had stress urinary incontinence as a result of the procedure. Urethral obstruction should be recognized as a potential complication following surgical correction of female stress urinary incontinence. Transvaginal urethrolysis is a safe and effective method to manage this problem.