Quiz - Reemex

Dear colleagues,

We want to share with you an interesting Urodynamic case.

You can send us your comments with your diagnostic impression and your therapeutic options.

We do have a clinical and Urodynamic follow-up that will be published in the next weeks.

A 77 year old woman had undergone a Reemex surgery (adjustable sling) 2 weeks before. She had undergone a colposuspension 10 years ago, with recurrence of her incontinence in the last 2 years.

She had a Urodynamic study performed 2 years ago elsewhere that was reported as a stable bladder with leakage with cough and a normal emptying phase, with no postvoid residual.

Her surgeon did not consider to update the study and performed the Reemex procedure without complications.

She had  acute retention after the procedure,  despite Immediate lowering of the sling tension. Due to persistent difficulty, an indwelling catheter was placed and she was referred for Urodynamics after 4 days of bladder cycling:

Uroflowmetry:  no flow was produced .

Cystometry

Cystometric capacity 61 ml

Pdet @ cys cap 33cmH2O

Involuntary contraction causing leakage

 

 

 

Pabd

 

 

Pves

 

Pdet

 

 

V inf

 

 

V ura

 

Q ura

 

 

 

 

 

P/F Study

Pdet @ Qmax 32 cmH2O

Qmax 3ml/s

PVR 45 ml

 

Can you please give us your diagnostic impression?

- Cystometry
- Pressure/ flow study

What treatment would you recommend?