Urinary retention after an anti-incontinence procedure

Question 1

On postoperative day 4 after placement of a suburethral sling for urinary stress incontinence, your patient has a postvoid residual volume of 250 mL. Before discharge from the hospital, the postvoid residual volume was 300 mL, and the patient was discharged with an indwelling bladder catheter. The surgery and postoperative course were otherwise uncomplicated. The best next step in management is to:

(A) release the sling
(B) start antibiotics
(C) replace the indwelling bladder catheter
(D) start intermittent self-catheterization
(E) perform urethral dilation

Answer 1

(D) start intermittent self-catheterization

Question 2

How often do patients experience incomplete bladder emptying after placement of a retropubic suburethral sling?

Answer 2

20-45% - BUT most resume adequate voiding in 4-6w

Question 3

How should voiding dysfunction (incomplete emptying) be managed after retropubic suburethral sling placement?

Answer 3

For 4-6w after procedure: intermittent self catheterization, urine culture (30% UTI risk after sling placement)

For >4-6w after procedure: start thinking about sling release