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

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.