Retropubic Vesicourethrolysis
The technique of retropubic or abdominal vesicourethrolysis has been described as a takedown of a retropubic repair that has resulted in urinary retention or significant voiding dysfunction. The goal of the operation is to free and mobilize the bladder and the proximal urethra. The procedure is performed as follows.
A large Foley catheter with a 30-mL balloon is placed inside the bladder. A transverse muscle–cutting incision, usually a Cherney incision (Fig. 35–1), is performed to facilitate exposure into the retropubic space. The bladder then is taken down sharply over the back of the symphysis pubis all the way down to the proximal urethra. It is best to make a high cystotomy to help in this dissection (Figs. 35–2 and 35–3). It is important to completely mobilize the bladder as well as the proximal urethra from the back of the symphysis. Very commonly, sutures or bone anchors from a previous suspension are encountered (Fig. 35–4). Dissection is extended laterally toward the pelvic sidewall and is taken down to the level of the arcus tendineus fasciae pelvis (white line) or the lower margin of the obturator internus fascia (Figs. 35–5 and 35–6
