- Stress urinary incontinence (SUI) in women is a common problem
- More than 200 procedures have been described
- Midurethral  slings (MUS) – Gold Standard
- Incidence of voiding dysfunction, including urinary retention, ranges from 2% to 25% (1)
- MUS surgical intervention for voiding dysfunction and urinary retention: 0% to 5% (1)

Obstructive symptoms
  - Urinary retention
  - Incomplete emptying
  - Obstructive voinding symptoms
  - Storage symptoms

Causes
  - Inadequate detrusor contraction
  - Excessive tension under urethra

How to make the diagnosis?
  - There is no universal definition of urinary retention
  - Transient urinary retention
  - Prolonged retention (> 4 weeks)
  - Voiding dysfunction
  - Failure to identify can lead to serious clinical sequelae

Case report

History and Physical Examination
- Female, 64-year-old
- 4-year history of stress urinary incontinence
- G3P3 (three vaginal labours)
- No pelvic surgery

Pelvic Examination 
- Normal external genitalia. urethra, bladder, and vagina were normal
- No pelvic organ prolapse

 Work-up 
- Urinalysis: normal
- Urine culture: negative
- Ultrasound: normal
- Urodynamic study
     - ALPP 82cmH2O
     - Qmax 18cmH2O
     - Pdetmax: 25cmH2O
     - PVR: zero

- Patient was submitted to transobturator midurethral tape out-in under spinal block
- The patient presented urinary retention immediately after surgery

Management of urinary retention - factors involved
 -  Lower detrusor pressure 
 -  Detrusor pressure X average flow rate  
 -  Urethral resistance was more important than  detrusor pressure (2) 
 -  No urodynamic parameters  predictive of postoperative retention

Postoperative retention rates, Figure 1 (3)
  - TVT: 2.3% to 19.5% 
  - TOT: 2.0% to 5.4%

Options treatment:
-  Intermittent self catheterisation
-  Indwelling foley catheter: remove every 3-4 days & trial of voiding

Loosen the tape:
    -  Cistoscopy
    -  Clamp

Patient was managed trough CIC for three days and then was submitted to tape mobilization (firmly pulled straight down) under local anesthesia presenting good result (normal voiding). Surgery video attached in Video Presentation

Potential benefits of early tape mobilization after mid-urethral surgery 
 
-  Procedure under local anesthesia
-  Resolution of voiding problems
-  Avoidance of long-term catheterization
-  Improve quality of life for patients

Taneja SS. In complications of Urologic surgery 4th ed. 2010. Saunders Elsevier
Sander P, Moller LM, Rudnicki PM, Lose G. Does the tension-free vaginal tape procedure affect the voiding phase? Pressure-flow studies before and 1 year after surgery. BJU Int. 2002;89:694–698
Bullock TL, Ghoniem G, Klutke CG, Staskin DR. Advances in female stress urinary incontinence: mid-urethral slings. BJU Int. 2006 Sep; 98 Suppl 1():32-40; discussion 41-2