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Vol. 36. Issue 6.
Pages 379-382 (June 2012)
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Vol. 36. Issue 6.
Pages 379-382 (June 2012)
Casuistry
Transvestibular urethrolysis
Uretrolisis transvestibular
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G. Carmignani??
Corresponding author
gcarmignani@unige.it

Corresponding author.
, A. Simonato, P. Traverso
Department of Urology, Clinica Urologica L. Giuliani, University of Genova, Génova, Italy
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Abstract
Objective

Bladder outlet obstruction with obstructive and irritative urinary symptoms may be a complication of surgery for female urinary incontinence. In the presence of persistent symptoms, the therapy is surgical and usually consists in an accurate urethrolysis. The way of approach is generally transvaginal. In this paper we propose and describe our experience with a transvestibular approach.

Material and methods

18 women who had undergone anti-incontinence surgery (TVT 12 pts, TOT 3 pts, Burch retropubic colposuspension 3 pts) with obstruction and/or irritative symptoms underwent a transvestibular urethrolysis. Five patients had urinary retention and the rest of the patients had post voiding residual urine>100ml. Using a scalpel blade a circum-meatal incision was performed and the urethra was progressively freed, dissecting just below the os pubis upwards and on the vaginal wall downwards, untethering it under direct vision in order to obtain a complete circular freeing of the urethra. In the end, the urethral meatus is repositioned with circular stitches.

Results

The operation lasts between 20 and 40min. An urethral catheter was left in place for 24–48h and no complications were observed. The post-voiding residual urine decreased in all of the cases and the irritative symptoms were reduced.

Conclusions

The transvestibular approach for urethrolysis is safe and effective regardless of the previous anti-incontinence surgery carried out. This procedure has the advantage of working in a relatively unscarred tissue, allows for a complete untethering of the urethra even in the retropubic space and leaves the vaginal wall intact.

Keywords:
Female urethra
Urinary incontinence surgery
Urethrolysis
Suburethral tape
Resumen
Objetivo

La obstrucción de la salida de la vejiga con síntomas obstructivos e irritativos es una posible complicación de la cirugía para la incontinencia urinaria femenina. Cuando los síntomas persisten el tratamiento es quirúrgico, y por lo general consiste en una uretrolisis precisa. La vía de acceso suele ser transvaginal. En este documento proponemos y describimos nuestra experiencia con una aproximación transvestibular.

Material y métodos

A 18 mujeres que fueron sometidas a una cirugía anti-incontinencia (12 con TVT, tres con TOT y tres con colposuspensión retropúbica de Burch) y que presentaban síntomas de obstrucción o de irritación se les realizó una uretrolisis transvestibular. Cinco pacientes tenían retención urinaria y las demás tenían una orina residual postvaciamiento mayor a 100ml. Con una hoja de bisturí se realizó una incisión alrededor del meato y la uretra fue progresivamente liberada, disecando justo por debajo del hueso púbico hacia arriba y en la pared vaginal hacia abajo, desvinculándola bajo visión directa para obtener una liberación circular completa de la uretra. Al final el meato uretral se vuelve a poner en su posición con puntos circulares.

Resultados

La operación dura entre 20 y 40 minutos. Se dejó un catéter urinario durante 24-48 horas y no se observó complicación alguna. El volumen residual postmiccional disminuyó en todos los casos y se redujeron los síntomas irritativos.

Conclusiones

La vía transvestibular es un enfoque seguro y efectivo para realizar la uretrolisis, independientemente del tipo de cirugía contra la incontinencia que se lleve a cabo. La uretrolisis tiene la ventaja de trabajar en un tejido relativamente intacto, permite una desconexión completa de la uretra incluso en el espacio retropúbico y mantiene la pared vaginal intacta.

Palabras clave:
Uretra femenina
Cirugía de incontinencia urinaria
Uretrolisis
Cinta suburetral

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