Case 2: Female Post-MUS Iatrogenic Bladder Outlet Obstruction

Clinical Scenario: 58yo Female presenting with voiding difficulty and hesitancy following mid-urethral sling (TVT) placement. Peak telemetry: Qmax = 9.0 mL/s, PdetQmax = 55 cmH2O.

Female Anatomical Model

Phase: Resting

Synchronized Telemetry (Qura, Pves, Pabd, Pdet, Pura, EMG)

Initializing female telemetry stream...
Timeline: 0s

Female Solomon–Greenwell Nomogram & Clinical Diagnostic

Solomon–Greenwell & Post-MUS Analysis

fBOOI: 41.5 PIP1: 64 cmH2O Void%: 62% Confidence: 95%
FEMALE BOO (POST-SLING OBSTRUCTION)

1. Solomon–Greenwell Criterion (fBOOI)

fBOOI Calculation: PdetQmax - (1.5 × Qmax) = 55 - (1.5 × 9.0) = 41.5
Diagnostic Verdict: Female BOO Confirmed (fBOOI > 18). High voiding pressure coupled with attenuated flow confirms true outflow resistance.

2. Detrusor Contractility Assessment (PIP1 / PIP2)

PIP1 Index: PdetQmax + Qmax = 55 + 9.0 = 64 cmH2O
Contractility Status: Normal / Preserved Detrusor Power. The detrusor actively generates high force to overcome mechanical urethral compression without secondary myogenic failure.

🎗️ Mid-Urethral Sling (Post-MUS) Specific Prognostic

Pathophysiology: Iatrogenic mechanical urethral tethering post-TVT placement. Fixed Pura (~52 cmH2O) despite complete pelvic floor EMG relaxation confirms physical mesh obstruction.

✔ Surgical Recommendation: Tape release, unilateral/bilateral tape incision, or formal urethrolysis. High probability of complete voiding restoration without recurrent SUI.

Clinical Pearl (ICS Guideline) Female voiding pressure is normally very low (< 20 cmH2O). A PdetQmax of 55 cmH2O post-TVT is pathognomonic for tape obstruction. Do not mistake this for detrusor-sphincter dyssynergia (DSD), as the EMG drops normally.

Solomon–Greenwell Female Plot

💬 AI Case Mentor & Discussion

Have questions about female BOO, TVT sling tensioning, fixed Pura pressure, or Solomon–Greenwell diagnostic thresholds? Ask our expert AI mentor below.

AI Mentor: Welcome to Case 2! You are reviewing a post-sling female BOO case (Qmax = 9.0 mL/s, PdetQmax = 55 cmH2O, fBOOI = 41.5). Notice how Pura does not drop during voiding initiation. What would you like to discuss?