ORIGINAL ARTICLE Bladder outlet obstruction after pubovaginal fascial sling Luís Gustavo M. Toledo & Fernando Korkes & Frederico R. Romero & Roni C. Fernandes & Celso Oliveira & Marjo D. C. Perez Received: 7 September 2008 / Accepted: 20 October 2008 # The International Urogynecological Association 2008 Abstract The purpose of this cross-sectional study was to evaluate patients’ satisfaction and urodynamic findings in women undergoing pubovaginal fascial sling procedure. We have evaluated, clinically and urodynamically, 45 women who underwent the rectus fascia pubovaginal sling for urodynamically proven stress urinary incontinence with at least 12 months of postoperative follow-up. After a mean follow-up of 25 months, 93.3% of patients reported being stress continent and 73.3% were satisfied with the result of the surgery. Patients with longer follow-up had a signifi- cantly lower satisfaction score (6.4 vs. 9.3, p =0.005). Using the Blaivas–Groutz nomogram, some degree of obstruction was observed in 51.1% of women. Storage symptoms were related to obstruction (p =0.004), longer follow-up (p =0.022), and negative impact on quality of life. Half of the patients had some degree of obstruction, which was directly related to urge syndrome and decrease in quality of life. Keywords Urinary incontinence . Stress . Urodynamics . Surgery . Quality of life . Urethral obstruction . Bladder Introduction Clinical data have proven the effectiveness of pubovaginal sling to female stress urinary incontinence (SUI). Its success rate varies from 80% to 90%, and the durability of results seems to be very satisfactory [1–3]. Clearly, to appreciate the clinical value of a treatment modality for SUI, one needs to look not only at objective cure rates but also patient’ s satisfaction with treatment [4]. Several studies have evaluated life impact and medical records after sling surgeries [2, 5–7]. However, no previous studies have evaluated indistinctively long-term urodynamic parameters after fascial pubovaginal sling procedure. Voiding symptoms are not directly associated with bladder outlet obstruction (BOO), and nomograms have been constructed to access its occurrence [8]. As BOO has the potential to lead to long-term complications on bladder function and composition, objective evaluation of BOO after sling procedure may provide insight about the mean- ings of long-term effects of pubovaginal sling procedure to bladder dynamics and quality of life [9]. In the present study, we have assessed patients with long follow-up after pubovaginal sling with clinical evaluation and urodynam- ics, despite postoperative symptoms, looking for BOO prevalence and its relationship with patients’ satisfaction and quality of life. Materials and methods Patient evaluation After institutional medical ethics committee approval, patients participating in this cross-sectional survey were recruited throughout the year 2005 to office visits by phone contact or telegram, and written informed consent was obtained. Of 54 patients who underwent pubovaginal sling procedure between 2000 and 2004, 48 could be contacted and came to office for evaluation. Exclusion criteria were sling material other than rectus fascia, neurogenic bladder, dystopia stage 2 or more, urinary infection at the time of evaluation, and less than 12 months of follow-up time. Int Urogynecol J DOI 10.1007/s00192-008-0759-8 L. G. M. Toledo : F. Korkes : F. R. Romero : R. C. Fernandes : C. Oliveira : M. D. C. Perez Division of Urology, Santa Casa of Sao Paulo Medical School, Sao Paulo, Brazil L. G. M. Toledo (*) Rua Aimbere, n 909, apt. 104, 05018-011, Sao Paulo, SP, Brazil e-mail: luisgtoledo@uol.com.br