Suture Injury to the Urinary Tract in Urethral Suspension Procedures for Stress Incontinence |
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Authors: | P L Dwyer M P Carey A Rosamilia |
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Institution: | (1) Royal Women’s Hospital and Mercy Hospital for Women, Melbourne, Australia, AU |
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Abstract: | The case histories of women attending the Urogynecology Department at the Royal Women’s Hospital and Mercy Hospital for Women
were reviewed between 1986 and 1998 to determine the incidence and postoperative morbidity caused by suture injury to the
urinary tract following urethral suspension surgery for stress incontinence. In our department 1103 Burch colposuspensions
and 61 Stamey urethral suspensions have been performed. Intraoperative cystourethroscopy was performed routinely for the early
detection and treatment of urinary tract injury. Intravesical sutures were found by routine intraoperative cystoscopy in 1
Stamey suspension, 1 open Burch colposuspension and 3 laparoscopic Burch colposuspensions. Ureteric suture ligation was diagnosed
in 2 women intraoperatively and 1 woman postoperatively after laparoscopic Burch colposuspension. Two women presented with
late complications from intravesical sutures following open Burch colposuspension. A further 7 women referred with urinary
symptoms were found to have intravesical sutures, 2 following Burch colposuspension, 4 following Stamey urethral suspension
and 1 following the Marshall–Marchetti–Kranz procedure. Seven of the 9 women diagnosed with intravesical sutures presented
with bladder or pelvic pain, frequency or urinary tract infection. Two women had recurrent stress incontinence and were found
to have a intravesical suture on routine cystoscopy at the time of stress incontinence surgery. Suture removal, with any accompanying
calculus, was achieved cystoscopically with almost immediate resolution of symptoms without loss of urinary control in all
cases. Non-absorbable intravesical sutures occurring as a result of suture misplacement or erosion is an infrequent but important
complication of stress incontinence surgery, but should be suspected if pain and irritative bladder symptoms or recurrent
urinary infection occur postoperatively. Cystourethroscopy performed intraoperatively or postoperatively is essential for
early diagnosis and treatment. |
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Keywords: | :Cystoscopy – Intravesical sutures – Stress incontinence surgery – Urinary tract injury |
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