Sling incision with associated vaginal wall interposition for obstructed voiding secondary to suburethral sling procedure

Obstructed voiding is a well recognized complication following a suburethral sling procedure. Current methods of transvaginal and transabdominal urethrolysis have had variable success rates in relieving the obstruction, and do not restabilize the urethra to prevent potential postoperative stress incontinence. We report on a procedure used in 4 cases which addresses both of these issues. All patients had persistent urinary retention beyond 8 weeks after a suburethral sling procedure. An oupatient procedure consisting of sling incision and associated tissue interposition (vaginal wall in three cases and fascia lata in one) was successful in relieving the obstruction. Continence status was maintained in 3 of the 4 patients. There were no major complications of this outpatient procedure.     

PROGRAM EVALUATION AND SERVICE MONITORING IN VICTORIAN COMMUNITY HEALTH CENTRES

This paper reports a survey of program evaluation and service monitoring activity in 49 Victorian community health centres. Centres generally have not made evaluation and monitoring an important part of their operations despite the rhetoric of health services policy makers and administrators. Reasons for this include a lack of staff in centres who are trained in evaluation methods; the reluctance of centre staff to divert time and resources from service provision to evaluation; and insufficient assistance to centres from the Health Commission of Victoria. “The assumptions that operating a service is equivalent to rendering service and that both are equivalent to rendering quality service are no longer being honoured as inherently valid.”¹