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Obstructive voiding affects up to 29% of the female population. The iatrogenic causes of female urinary obstruction are preventable to an extent and deserve special consideration. These include urethral stricture and obstruction following surgery for stress urinary incontinence. An understanding of the etiology and diagnosis of these two forms of obstruction is necessary for successful identification and management of these conditions. The most commonly used approaches to diagnosis include urethroscopy, voiding cystourethrography and flurourodynamics. Treatment methods proven successful for urethral stricture include dilatation, urethroplasty, flaps, and grafting. Common treatment approaches for obstruction following surgical correction of SUI include catheterization, urethrolysis, and sling incision. This review will further examine the etiology, diagnosis, and treatment of urethral stricture and obstruction after surgery with the intent of contributing to a consensus on diagnostic approach and management of these conditions. have explored methods in addressing the diagnosis and treatment of female urethral stricture with varied results. Stress urinary incontinence is a common condition affecting women, especially as the population ages. Common surgical approaches to this diagnosis include transobturator tape and retropubic sling procedures. However, surgical treatment is not without complications, which can range in presentation from transient to permanent urethral obstruction [6,7]. Nitti reports that the incidence of obstruction after incontinence surgery can range from 2.5 to 24% [1]. Obstruction after surgery may cause symptoms of hesitancy, decreased urinary flow, urgency, and frequency. In addition, other irritative symptoms such as pain, dysuria, and nocturia can occur. Petri and Ashok observed that obstructive symptoms more commonly occur with retropubic tapes compared to the transobturator tapes [8]. A high index of suspicion for obstruction is necessary for post-operative patients presenting with these lower urinary tract symptoms. There is still debate regarding diagnosis of post-surgical obstruction, and recent studies have also focused on proper management of obstruction in the post-surgical patient. This paper will examine the etiology, diagnosis, and management of obstruction following anti-incontinence surgery and urethral stricture.

Anatomical Causes of Female Obstructive Voiding: Urethral Stricture and Anti-Incontinence Procedures