Ureteral blockage as a complication of Burch colposuspension: report of 6 cases

Burch colposuspension for correction of urinary incontinence is rarely followed by complications. A very rarely described complication is ureteral kinking, which tends to occur in patients with previous pelvic surgeries. We present 6 additional cases of this rare complication and recommend appropriate intraoperative dissection as well as postoperative alert for early diagnosis, which improves prognosis.     

Staple erosion into the bladder after mesh and staple laparoscopic colposuspension. A case report

BACKGROUND: As new variations of operations are performed, complications must be recognized and reported. Erosion of staples into the bladder following mesh and staple laparoscopic colposuspension is a complication that must be anticipated, recognized and managed by the laparoscopic surgeon. CASE: A woman presented, four years after mesh and staple colposuspension for stress urinary incontinence, with bladder pain and hematuria. A staple was seen under the urothelium in the bladder dome and was removed cystoscopically, with resolution of symptoms. CONCLUSION: This is an avoidable complication of an increasingly performed procedure. Correction can be effected cystoscopically if the staple is visible.     

Laparoscopic retropubic colposuspension (Burch procedure)

Laparoscopic retropubic colposuspension (Burch procedure) was performed in 107 patients for the treatment of genuine stress urinary incontinence. The overall success rate was 97.2%, and overall complication rate 10.2%. Patients experienced minimal blood loss, shorter hospital stay, and faster recovery than with the traditional approach by laparotomy, confirming the findings of an initial study of 58 patients. Although follow-up has been relatively short (range 3–27 mo), it appears that laparoscopic retropublic colposuspension is a feasible and safe alternative to the abdominal procedure in appropriately selected patients.     

The incidence of genital prolapse after the Burch colposuspension.

OBJECTIVE: Our objective was to determine the incidence of postoperative genital prolapse after the Burch colposuspension and to identify risk factors for the development of subsequent prolapse. STUDY DESIGN: The charts of 131 patients who had a Burch colposuspension performed by the senior author (S.L.S.) between 1977 and 1986 were reviewed at the Urodynamic Unit of St. George's Hospital, London. Emphasis was placed on the degree of genital prolapse on clinical examination and whether further surgery was required to correct the prolapse. RESULTS: Thirty-five patients (26.7%) required a total of 40 operations to correct genital prolapse after colposuspension. At 20 operations, more than one procedure was required to correct combined prolapse. The patient's age, weight, parity, menopausal status, and prior pelvic surgery did not affect the incidence of postoperative prolapse. The only preoperative risk factor identified was the presence of a large cystocele. CONCLUSION: Postoperative genital prolapse is a significant complication of the Burch colposuspension. It is unclear whether this is due to a disruption of the vaginal axis or to an intrinsic weakness of the pelvic floor in these women.     

Colposuspension in the treatment of stress urinary incontinence: long-term yield]

Surgery in 227 cases of urinary stress incontinence (USI) associated to other abdominal and/or vaginal pathologies, by means Burch colposuspension, has given a success rate of 90.3% recovery of USI 6.6% improved urinary incontinence grade, an 98.3% recovery rate of the concomitant genital prolapse, in a follow-up period mean of 42 moths. Postoperative complication of the surgical procedure are analized.     

Vaginal revision of irritation of the obturator nerve within colposuspension

Irritation of the obturator-nerve within colposuspension is a possible complication because of topographic proximity between obturator-nerve and operating-field. The main symptoms are weakness of the adductor muscles, sensory disturbance of thigh till paralysis and pain in the operating- field early after surgery. Too lateral fixing of the sutures in the pectineal ligament above the obturator-channel can cause compression of the obturator-nerve. Precocious intervention is a precondition for complete remission of symptoms, retropubic revise of surgery is evident. The method outlined here describes vaginal access for re-surgery with lateral colpotomy and dissection of the proximal colposuspension s suture. In this way a recurrent laparotomy with additional trauma of the operating-field can be avoided. In the case described here, this method led to the patients complete remission.     

Outcomes and surgical therapeutic index of Burch colposuspension in stress urinary incontinence

OBJECTIVE: To apply the new concept of a surgical therapeutic index to patients who suffer from stress urinary incontinence using the cure rate and complication rates of Burch colposuspension and to develop a preoperative counseling tool and objective comparison tool for the many surgical procedures that have been described. STUDY DESIGN: We reviewed the case histories of 22 patients between March 1999 and March 2000 who had stress urinary incontinence and underwent Burch colposuspension and in whom the diagnosis of stress urinary incontinence was made using urodynamic studies and the cotton-tipped-swab test. The surgical therapeutic index was then calculated using the median percentage cure rate and complication rate. RESULTS: The surgical cure rates were 81.8%, 81.8%, 90.9%, 90.9%, 95.4% and 95.4% at postoperative 1st, 3rd, 5th, 7th, 9th and 12th month, respectively, and the surgical complication rates were 69%, 36%, 31.5%, 27%, 22.5% and 27%. The surgical therapeutic indices for each postoperative period were 1.19, 2.27, 2.89, 3.37, 4.24 and 3.53, respectively. The surgical cure rate for Burch colposuspension in stress urinary incontinence was 95.4% 1 year after surgery, and the surgical therapeutic index 1 month and 1 year after surgery was 1.19 and 3.53, respectively. CONCLUSION: Burch colposuspension is a relatively effective and safe surgical procedure for managing stress urinary incontinence.     

Kontinenzwiederherstellende Operationsverfahren in der Gyn?kologie

As a prevalent indisposition female urinary incontinence is partly associated with a significant reduction of self-determined lifestyle. In addition to conservative therapy approaches there are also several surgical options. Worldwide, tension-free vaginal tapes are most commonly applied for the surgical treatment of stress urinary incontinence and transvaginal tapes as well as transobturator tapes convince with high effectiveness and low complication rates. Another regularly used option is colposuspension, often applied additionally during abdominal surgical interventions or used for the effective treatment of a lateral defect of the anterior vaginal wall. Due to a negative long-term outcome, periurethral injections are reserved for special indications and should not primarily be used if more effective surgical methods are available. Intravesical injection of botulin is a surgical option used as treatment of an overactive bladder after unsuccessful therapy with anticholinergic drugs. Patients with therapy-resistant and refractory overactive bladder syndrome may benefit from sacral neuromodulation.     

Postoperative Pubic Symphysis Osteomyelitis after Laparoscopic Two-team Sling with Anterior and Posterior Colporrhaphy

A 53 year-old woman, who previously had a Burch colposuspension, developed osteomyelitis of the pubic symphysis about 1 month after undergoing a laparoscopic 2-team sling with anterior and posterior colporrhaphy. The diagnosis was made on the basis of computed tomography–guided aspiration of the pubic symphysis, which was positive for group B Streptococcus sp. To our knowledge, this is the first case report of osteomyelitis after a laparoscopic retropubic sling procedure. Osteomyelitis is a rare postoperative complication in female pelvic reconstructive surgery but has been reported in cases where the pubic bone is used for anchoring. It is especially unusual in this case because the pubic symphysis was not used for securing the sling.     

The value of simultaneous hysterectomy during Burch colposuspension for urinary stress incontinence

The effect of concomitant hysterectomy during colposuspension on the cure rate of genuine stress incontinence was evaluated prospectively in 45 patients. Twenty-two women underwent a colposuspension only (no-hysterectomy group) and 23 had a concomitant abdominal hysterectomy and cul-de-sac obliteration (hysterectomy group). Twenty-five months postoperatively, no differences were found in the cure rate for urinary stress incontinence between the two groups (95.5 and 95.7% for the no-hysterectomy and the hysterectomy group, respectively). In the no-hysterectomy group, three patients (13.6%) had enterocele formation after surgery; this complication did not occur in any of the patients in the hysterectomy group.     

Laparoscopic colposuspension and tension-free vaginal tape: a systematic review

BACKGROUND: Advances in surgical techniques have led to the availability of a number of minimal-access procedures to treat urodynamic stress incontinence (USI). These procedures have been individually compared with the 'gold standard' open Burch colposuspension; however, it now seems appropriate to compare like with like and compare these minimal-access techniques with each other. OBJECTIVES: To determine the effectiveness of laparoscopic colposuspension with tension-free vaginal tape (TVT) for the treatment of USI. SEARCH STRATEGY: Randomised trials in woman with USI, which compared laparoscopic colposuspension with TVT in the arms of the trial, were identified from the Cochrane Incontinence Review Group's Specialised Register of Controlled Trials. SELECTION CRITERIA: The trials were evaluated for methodological quality and appropriateness for inclusion by the reviewers using the Incontinence Group's assessment criteria. DATA COLLECTION AND ANALYSIS: The data were extracted independently, and when appropriate, meta-analysis was undertaken to calculate pooled estimates and their confidence intervals (CI). The main outcomes measured were: subjective cure, objective cure, quality of life (QoL) measurements, surgical outcomes and health economic measures. MAIN RESULTS: Seven trials compare laparoscopic colposuspension (n= 264) with TVT (n= 290). There was no statistically significant difference in the reported subjective cure rate between laparoscopic colposuspension and TVT within 18 months (relative risk [RR] 1.12, 95% CI 0.98-1.29). However, within the same time period, the overall objective cure rate was statistically significantly higher for TVT (RR 1.16, 95% CI 1.07-1.25). There were no significant differences between the two procedures with regards to perioperative complication, de novo detrusor overactivity, voiding dysfunction, procedural costs and QoL scores. However, TVT procedure is quicker to perform and has a shorter hospital stay. CONCLUSIONS The evidence so far appears to be in favour of the TVT as the minimal-access technique of choice for USI in comparison with laparosopic colposuspension; however, long-tem data are needed. Further well-designed trials with standardized outcomes are required to draw accurate conclusions from this comparison.     

Colposuspension and transvaginal bladder neck suspension in the treatment of stress incontinence

The present work was performed to evaluate the clinical usefulness of colposuspension in stress urinary incontinence without uterovaginal descent and bladder neck suspension in cases with uterovaginal descent. Modified Burch colposuspension was performed in 29 patients and modified Raz bladder neck suspension in 19 patients. The patients were examined clinically and urodynamically before and 8-12 months after operation. All patients in the colposuspension group regarded themselves as being totally continent postoperatively. In the bladder neck suspension group the respective figure was 58%, plus 21% showing improvement and 21% failures. Urodynamically, the cure rates (positive urethral closure pressure at stress) were 100% for colposuspension and 79% for bladder neck suspension. After colposuspension the urethral closure pressure at stress and the pressure transmission ratio were significantly increased whereas successful bladder neck suspension increased only urethral closure pressure at stress. The failed bladder neck suspensions did not induce any urodynamic changes. The present data confirms that Burch colposuspension is effective in stress urinary incontinence in women without simultaneous uterovaginal descent, whereas bladder neck suspension by the modified Raz technique did not appear to be optimal for the treatment of stress incontinence in patients with uterovaginal descent.     

Colposuspension for the Treatment of Female Urinary Incontinence

Between June 1, 1983 and June 30, 1988, 174 patients with stress incontinence were treated with a colposuspension operation; 144 patients were cured, 30 remained wet. Sixteen patients who remained wet had detrusor instability; 9 of these were cured by anticholinergic medications. Of 25 patients who had dual pathology 19 were cured. Seventy nine patients had urinary tract infections. Two patients had ureteric obstruction due to kinking; it is postulated that this can be an infrequent and sometimes unavoidable complication.     

Surgical procedures in urogynaecology

All current surgical procedures for genuine stress incontinence are associated with a significant risk of failure and the possibility of causing new problems such as detrusor instability and voiding dysfunction. In addition, procedures may be complicated by other perioperative morbidity. A number of new procedures are now available which reduce the invasiveness of the surgical treatment as well as increasing the options available for those where primary surgery has failed. Alternative approaches such as laparoscopic colposuspension may reduce the morbidity of the open colposuspension as well as hastening recovery. Data on outcome are of poor quality and further research is required to establish whether this is a useful technique. Tension-free vaginal tape is a relatively minor procedure with promising early results although follow up is needed to determine long-term cure and exclude problems with erosion. Periurethral bulking agents appear to be safe and associated with few problems; they are minor procedures but are not associated with as high success rates as more major surgery. Clam ileocystoplasty is an option for the management of severe intractable detrusor instability with dramatic relief of symptoms possible. Patients undergoing such major surgery need to be counselled fully about the possible morbidity.     

Surgical options in the treatment of stress urinary incontinence in women

The aim of this review is to provide an update on the surgical options for treatment of stress incontinence in women. The efficiency of different procedures and the safety associated with each procedure are evaluated, mainly by reviewing the randomised controlled trials. The open retropubic colposuspension and the sling procedures are the most efficacious for treatment stress urinary incontinence especially in the long term. The laparoscopic colposuspension may be as good as the open colposuspension, but the long-term performance remains uncertain. The newer minimal access vaginal sling procedures appear to offer benefits of minimal access surgery with success rate similar to the colposuspension and the traditional slings and minor morbidity in the short and median-term. However long term data is still awaited. The transobturator technique does not seem to provide advantages compared to the classical TVT procedure. Urethral injection therapy does not seem to have the same efficacy as conventional surgery and long term data is still scanty. However, because of low operative morbidity it represents a favourable alternative to standard surgery in patients who prefer less invasive treatment, the frail elderly and other selected women where conventional surgery is problematic.     

Laparoscopic versus open colposuspension: which one should we choose?

PURPOSE OF REVIEW: The aim of this review is to present a summary of recently published research comparing laparoscopic and open colposuspension. It also examines the place of colposuspension in light of the continuing development other minimally invasive procedures for stress urinary incontinence. RECENT FINDINGS: The results of two large multicentre randomised controlled trials were published in 2006 comparing open and laparoscopic colposuspension. Carey et al. randomised 200 women to open or laparoscopic colposuspension. The primary outcome objective was cure 6 months postoperatively. Cure was defined as the absence of urodynamic stress incontinence. Patients' subjective outcomes were assessed 3-5 years postoperatively. Kitchener et al. reported a randomised controlled trial in which 291 women were recruited. The primary end point of the study was objective cure at 2 years. This was defined as <1 g of urinary leakage during a 1 h standardised pad test. Both trials demonstrated no significant differences between laparoscopic and open colposuspension in objective and subjective measures of cure of stress urinary incontinence at 24 months. SUMMARY: There is now level 1 evidence that the clinical outcomes with laparoscopic Burch colposuspension are similar to open Burch colposuspension.     

Voiding difficulties after colposuspension

To study subjective and objective changes of micturition after colposuspension, 80 patients were evaluated before and after surgery. It was found that colposuspension may introduce an element of urethral obstruction, which leads to a significant proportion of immediate as well as late voiding difficulties. Thus, 25% of the patients developed severe voiding difficulties in the immediate postoperative course. Low pressure voiding (Pdet less than 15 cm water) preoperatively was found to predispose significantly to immediate postoperative voiding difficulties. Another 20% developed late voiding difficulties. Increased urethral resistance preoperatively was found to predispose significantly to late postoperative voiding difficulties. Increased urethral rigidity is suggested as an underlying factor. Only four (5%) of the patients developed both immediate and late postoperative voiding difficulties. The detrusor pressure at maximum flow was found to be an unreliable parameter in assessing the true potential of the detrusor. It is emphasized that a thorough preoperative evaluation of both bladder and urethral function and the use of a proper surgical technique are required to avoid voiding difficulties after colposuspension.     

Laparoscopic burch colposuspension: comparison of effectiveness of extraperitoneal and transperitoneal techniques

OBJECTIVE: To compare the effectiveness of two different laparoscopic colposuspension procedures: extraperitoneal approach using mesh fixed with tacks, and transperitoneal approach using sutures. STUDY DESIGN: We conducted a retrospective study of all patients (n = 64) who had undergone two different techniques of laparoscopic Burch colposuspension without additional surgeries over a 6-year period. Thirty-six women underwent laparoscopic transperitoneal colposuspension with using nonabsorbable sutures (group A), whereas 28 women underwent laparoscopic extraperitoneal colposuspension with using mesh and preperitoneal balloon dissection technique (group B). Cure rate was assessed by simple cystometry with a cough stress test in the standing position. Both groups were compared with regard to cure rates, operative time, length of hospital stay, complications, estimated blood loss, and total hospital charges. RESULTS: The mean times to follow-up were 25.7 months in the group A and 27.3 months in the group B (P = 0.082). At last follow-up, 33 of 36 (91.7%) patients in the group A and 23 of 28 (82.1%) patients in the group B were continent (P = 0.22). The other results were as follows for group A and B, respectively: average duration of surgery, 58.1 compared with 46.8 min (P = 0.001); average hospital stay, 2.05 compared with 1.57 days (P = 0.02); the intraoperative complication rate, 8.3% compared with 7.1% (P = 0.62). The total hospital charges for the group B were found significantly higher (US dollars 2,234 versus US dollars 1,348, P = 0.001). CONCLUSION: Although we found higher cure rates in laparoscopic colposuspension with the transperitoneal approach using sutures than the extraperitoneal approach using mesh fixed with tacks, there was no statistically significant difference between the two procedures. In comparison with extraperitoneal mesh technique, lower cost is the superiority of the transperitoneal suture technique.     

Cost-analyzes based on a prospective,randomized study comparing laparoscopic colposuspension with a tension-free vaginal tape procedure

BACKGROUND: The aim of this study was to compare laparoscopic colposuspension with tension-free vaginal tape (TVT) in terms of costs to the county. METHODS: In a prospective, randomized study, we approached 270 consecutive women presenting for evaluation of stress urinary incontinence symptoms at one university hospital. Preoperatively, and at 1-year follow-up, the women underwent urodynamic evaluation, an ultra-short pad-test and completed a lower urinary tract symptoms questionnaire. We randomized 79 consenting, eligible women to either procedure; a 1-year follow-up examination was performed on 68/71 (96%) women that were available. The procedures were performed as described previously. Main outcome measures were all relevant costs for goods and services associated with the procedures. RESULTS: The baseline characteristics of the two groups were similar. The TVT procedure was performed significantly faster than the laparoscopic colposuspension, i.e. 44.9 +/- 14.2 min compared with 60.5 +/- 13.4 min (p < 0.0001). Even so, procedural costs were significantly lower for laparoscopic colposuspension than for TVT (euro 1273.4 compared with euro 1342.8 p < 0.001). At the 1-year follow-up visit, three women operated on with TVT and one operated on with laparoscopic colposuspension required re-operation for continuous stress urinary incontinence. One women operated on with TVT had her sling cut for bladder-emptying problems. Total costs, including re-operations were euro 1462.6 for a TVT procedure andeuro; 1314.5 for a laparoscopic colposuspension. CONCLUSION: In our hands, the laparoscopic colposuspension was less expensive to the county than the TVT procedure.     

Laparoscopic Burch colposuspension

PURPOSE OF REVIEW: This review will describe the recent literature regarding laparoscopic Burch colposuspension. RECENT FINDINGS: A 2006 Cochrane review found laparoscopic Burch colposuspension to be equivalent to open Burch colposuspension regarding subjective cure rate, but a reduced objective cure rate was reported. Three subsequent randomized trials have not identified any significant difference between the two procedures with respect to subjective or objective cure rates. Three additional prospective cohorts found cure rates of 76-95%. Another randomized controlled trial found laparoscopic Burch colposuspension with mesh and staples to be inferior to using sutures. There have been no new trials comparing laparoscopic Burch colposuspension and tension-free slings since the Cochrane review. SUMMARY: Laparoscopic Burch colposuspension is an effective treatment for stress urinary incontinence and is equivalent to open Burch colposuspension. Success is affected by the surgeon's experience and surgical technique. No difference in subjective cure rates has been identified in comparison with tension-free slings; however, objective cure rates favor tension-free slings. We believe that laparoscopic Burch colposuspension is the procedure of choice in women undergoing pelvic-floor repair and concomitant retropubic surgery, and in young women, because it avoids the potential complications of mesh. More research comparing the two procedures is indicated.