A surgical technique to adjust bladder neck suspension in laparoscopic Burch colposuspension.

Full Abstract

STUDY

OBJECTIVE:
To evaluate the anatomic and functional efficacy of a surgical technique designed to prevent overcorrection of the bladder neck in laparoscopic Burch colposuspension for primary urodynamic stress incontinence.

DESIGN:
Prospective, observational study (Canadian Task Force classification II-2).

SETTING:
Medical center, Taipei, Taiwan.

PATIENTS:
One hundred fifty-five consecutive women, aged 33 to 71 years, undergoing laparoscopic Burch colposuspension for primary (not previously operated on) urodynamic stress incontinence were prospectively assessed over a 6-year period.

INTERVENTIONS:
A bladder neck suspension technique, derived from serial perioperative ultrasound examinations for open Burch colposuspension, was incorporated into laparoscopic Burch procedure.

MEASUREMENTS AND MAIN RESULTS:
The outcome measures included duration of postoperative voiding trials, morphologic changes on ultrasound scanning within 1 month of operation, postoperative continence rate, persistent or de novo urge symptoms or detrusor overactivity, and therapeutic satisfaction for laparoscopic Burch colposuspension. At 1-year follow-up, the objective cure rate was 94.8% (110/116), subjective cure rate was 95.7% (111/116), and overall therapeutic satisfaction was 92.2% (107/116). Kaplan-Meier analysis revealed the cumulative rates for subjective cure of stress incontinence and freedom from urge symptoms at 1, 3, and 5 years were 95.7%, 90.7%, and 76.5%, and 92.7%, 90.4%, and 90.4%, respectively. Four women (2.6%) had prolonged voiding trials greater than 1 week. Urge symptoms occurred in 12 women (7.7%), and de novo detrusor overactivity occurred in 6 (3.9%). Demographic factors, concomitant surgical procedures, and perioperative morphologic variables did not correlate with prolonged voiding trials or postoperative urge symptoms.

CONCLUSIONS:
Our standardized surgical technique may help to avoid overelevation and associated postoperative complications without compromising the success of laparoscopic colposuspension for primary urodynamic stress incontinence.

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Author information

Author/s: Yang, Jenn-Ming (JM); Yang, Shwu-Huey (SH); Huang, Wen-Chen (WC);

Affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: Journal of minimally invasive gynecology (J Minim Invasive Gynecol), published in United States. (Language: eng)

Reference: -2006 Jul-Aug; vol 13 (issue 4) : pp 289-95

Dates: Created 2006/07/07; Completed 2006/08/31; Revised 2006/11/15;

PMID: 16825068, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Suture Techniques
Urethra - ultrasonography
Urinary Bladder - surgery
Urinary Incontinence, Stress - physiopathology; surgery
Urodynamics
Urologic Surgical Procedures - methods

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