L L Wall1, J K Hewitt. 1. Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA.
Abstract
OBJECTIVE: To evaluate changes in voiding function before and after Burch colposuspension for genuine stress incontinence. STUDY DESIGN: Full urodynamic evaluations were performed before and three months after surgery on 21 patients undergoing Burch colposuspension for genuine stress incontinence. Sixteen patients underwent the Burch procedure alone and five underwent an abdominal sacral colpopexy for vaginal vault prolapse in addition to the Burch procedure. The preoperative and postoperative urodynamic studies were compared with each other to see what changes in voiding function had occurred as the result of surgery. RESULTS: Statistical analysis of the differences between the preoperative, and postoperative urodynamic studies using blocked analysis of variance showed dramatic decreases in both instrumented and noninstrumented peak and mean urine flow rates and an increase in detrusor pressure at peak urinary flow during voiding. A substantial but not statistically significant increase in mean residual urine was found after surgery in patients who underwent the Burch procedure alone. There were no statistically significant differences in these parameters in patients undergoing the Burch procedure combined with abdominal sacral colpopexy. Using the criteria of a flow rate of < 12 mL/sec in association with a voiding detrusor pressure > 50 cm H2O, five patients undergoing the Burch procedure alone had evidence of postoperative outflow obstruction. Three women with complete vaginal vault prolapse had functional outlet obstruction before surgery, and another three women had postoperative outlet obstruction following the combined Burch procedure and sacral colpopexy. CONCLUSIONS: Burch colposuspension produced significant changes in postoperative voiding function three months after surgery, and outflow obstruction induced by surgery appeared to be a significant potential complication. Renewed attention should be devoted to the development of durable but nonobstructive operations for the surgical cure of genuine stress incontinence.
OBJECTIVE: To evaluate changes in voiding function before and after Burch colposuspension for genuine stress incontinence. STUDY DESIGN: Full urodynamic evaluations were performed before and three months after surgery on 21 patients undergoing Burch colposuspension for genuine stress incontinence. Sixteen patients underwent the Burch procedure alone and five underwent an abdominal sacral colpopexy for vaginal vault prolapse in addition to the Burch procedure. The preoperative and postoperative urodynamic studies were compared with each other to see what changes in voiding function had occurred as the result of surgery. RESULTS: Statistical analysis of the differences between the preoperative, and postoperative urodynamic studies using blocked analysis of variance showed dramatic decreases in both instrumented and noninstrumented peak and mean urine flow rates and an increase in detrusor pressure at peak urinary flow during voiding. A substantial but not statistically significant increase in mean residual urine was found after surgery in patients who underwent the Burch procedure alone. There were no statistically significant differences in these parameters in patients undergoing the Burch procedure combined with abdominal sacral colpopexy. Using the criteria of a flow rate of < 12 mL/sec in association with a voiding detrusor pressure > 50 cm H2O, five patients undergoing the Burch procedure alone had evidence of postoperative outflow obstruction. Three women with complete vaginal vault prolapse had functional outlet obstruction before surgery, and another three women had postoperative outlet obstruction following the combined Burch procedure and sacral colpopexy. CONCLUSIONS: Burch colposuspension produced significant changes in postoperative voiding function three months after surgery, and outflow obstruction induced by surgery appeared to be a significant potential complication. Renewed attention should be devoted to the development of durable but nonobstructive operations for the surgical cure of genuine stress incontinence.