Laparoscopic burch and paravaginal repair and incidence of lower urinary tract injury

Abstract

Objective: This study was undertaken to determine the rate of injury to the lower urinary tract during laparoscopic Burch urethropexy and/or paravaginal repair.Methods: The charts of 159 consecutive patients from January 1997 to July 1999 who underwent laparoscopic Burch and/or paravaginal repair were reviewed. All patients had intraoperative transurethral video cystoscopy performed with intravenous injection of indigo carmine dye to assess potential injury to the bladder or ureter.Results: Lower urinary tract injury was diagnosed in 4 of 159 (2.5%) patients having laparoscopic Burch and/or paravaginal repair. All 4 injuries were cystotomies with 3 occurring during Burch urethropexy and 1 during a paravaginal repair. Two of these patients had previous open retropubic urethropexies (1 MMK and 1 prolene mesh urethropexy). No ureteral ligations or intravesical suture placement were diagnosed. No statistical differences in demographics or surgical parameters were found when comparing patients with and without injuries.Conclusions: Despite most patients in this study having both Burch urethropexy and paravaginal repair, the lower urinary tract injury rate of 2.5% is much lower than the reported injury rate of 10% for patients who have Burch urethropexy alone performed via laparotomy. The reported benefits of laparoscopy, including less blood loss and better visualization may explain the lower incidence of injury. The authors believe the laparoscopic approach, performed by experienced surgeons, may reduce lower urinary tract injury during anterior vaginal wall reconstruction.