Laparoscopic Burch Colposuspension with the Choi's Hook / 대한산부인과학회지

OBJECTIVE: Burch operation has been effective method for the treatment of stress incontinence. Burch operation is a well-accepted procedure for treating stress urinary incontinence secondary to urethral hypermobility without intrinsic sphincter deficiency and is the reference standard with which other procedures are compared. This study is to evaluate the effectiveness of the Choi's hook in laparoscopic Burch operation. METHODS: This study included 47 patients who had undergone laparoscopic Burch operation from October 2000 through March 2005. Of these 47 patients, 27 patients underwent traditional laparoscopic Burch operation (Group 1) and 20 patients underwent laparoscopic Burch operation with Choi's Hook on anchoring the endopelvic fascia to the Cooper's ligament (Group 2). RESULTS: The mean age of patients of Group 1 was 55.6+/-9.37 years of age and that of Group 2 was 56.0+/-5.93 years of age. There is no difference in the mean age of patients (P>0.05). The mean operating time was 90.5+/-15.32 minutes for Group 1 and 38.5+/-10.14 minute for Group 2. The mean operating time was shorter in Group 2 than Group 1 (P0.05). CONCLUSION: We performed laparoscopic Burch operation with the Choi's Hook on anchoring the endopelvic fascia to the Cooper's ligament. When we compared traditional laparoscopic Burch operation with laparoscopic Burch operation with Choi's Hook, we could shorten the operation time using the Choi's Hook.

Long Term Follow-up Results of Extraperitoneal Laparoscopic Burch Bladder Neck Suspension / 대한비뇨기과학회지

PURPOSE: Despite the encouraging short-term results after the laparoscopic Burch operation for female stress urinary incontinence, many investigators reported the decreases of the success rate on long-term follow up studies. These facts have urged us to investigate the change of success rate on long term follow up and related factors of them. MATERIALS AND METHODS: This study was performed for 39 patients who have received laparoscopic Burch operation from May 1995 to December 1996. Mean follow up duration was 41 months (32-50 months). Extraperitoneal approach was performed in all cases, and postoperative 3 months and long term follow-up results were assessed using standardized questionnaire and medical record. Symptom grades were categorized by Stamey grade. Factors affecting postoperative outcome and complications were also analyzed. RESULTS: On 3 month short term follow-up, 64.1% were cured and 28.2% were improved. However, on the long term follow-up, success rates were droped to 46.1% and 25.6% respectively. Factors affecting postoperative outcome were preoperative Stamey grade and VLPP. Age, parity, symptom's duration, body weight had no correlation with post-operative results. Of the 12 patients with preoperative symptoms of urgency and/or urge incontinence, 8 patients reported those were disappeared or decreased postoperatively. Obstructive symptoms occurred in 7 cases, but progressively improved with time. CONCLUSIONS: With these results, we could conclude that initial success rate of laparoscopic Burch operation is high, but it declined with time. However, on the basis of the result that Stamey grade I patient had lower failure rate, we could selectively apply this operation for grade I stress urinary incontinence.

Comparison of Extraperitoneal Laparoscopic Burch Operation versus Raz Operation for Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: Results of extraperitoneal laparoscopic bladder neck suspension(BNS) and that of Raz procedure for the correction of stress urinary incontinence (SUI) were analyzed retrospectively. MATERIALS AND METHODS: Among 39 patients who underwent laparoscopic BNS for anatomical SUI, 28 patients had follow-up study at postoperative 6 months. All 87 patients who underwent Raz procedure were also followed up at postoperative 6 months. RESULTS: Mean operation time in laparoscopic BNS was 138 min initially but, was shortened to 95 min. after using 'thick (5 mm) knot pusher'; whereas mean operation time in Raz group was 56min. Return to normal voiding and mean duration of hospital stay were possible in 1.2 days and 2.6 days in laparoscopic group and 11.9 days and 4.5 days in Raz group with significant difference between 2 groups. Amount of residual urine at discharge was less than 100cc In all except 1 case in laparoscopic group(27/28, 96%). However in Raz group, 35 patient(40%) still showed residual urine of more than 1 00ml at the time of discharge. Postoperatively, voiding difficulty was noted in 3, frequency in 15, bleeding in 2, dyspareunia and bladder stone in 1 case for Raz group; In laparoscopic group, frequency was noted in 3, voiding difficulty in 2, needs of transfusion in 2 cases. 26 of 28 patients(85%) were completely dry or Improved in laparoscopic group; 82 of 87 patients(93%) In Raz group also showed complete dryness of improvement without significant difference in success rate between 2 groups. CONCLUSIONS: From our results, laparoscopic bladder neck suspension could shorten the duration of hospital stay and time to regaining normal voiding with early catheter removal. High success rate was also comparable to those of Raz operation. Laparoscopic BNS could applies as erective treatment modality for the surgical correction of anatomical stress urinary incontinence with its less invasiveness and early return to normal activities compared with the Raz procedure.

The Experience of Transvaginal Burch Operation for Genuine Stress Incontinence / 대한비뇨기과학회지

A total of 32 female patients with genuine stress urinary incontinence underwent Raz needle suspension with fixation of suspension sutures to the iliopectineal ligament (transvaginal burch procedure) from July 1995 to December 1996. Mean age of the patients was 47 years (range; 31~64 years). The duration of the incontinence was 5 years in average (range; 2~12 years). In the degree of severity, 25 patients were Grade II and 7 patients were Grade I. Mean parity was 3 (range; 1~5 times). The duration of follow up was 7 months in average. Incontinence was completely disappeared in 29 patients (91%) and significantly improved in 3 patients (9%). There was no serious operative complications such as bleeding needed transfusion. But temporary urinary retention (5), suprapubic pain (9), vaginitis (3) and urinary tract infection (4) were noted. By fixing suspension sutures to the iliopectineal ligament we expected to achieve a static suspension independent of patient activities. Because of short term follow-up and small number of cases, long term follow-up and additional number of cases are needed, but, so far, results are satisfactory with 91% continence and minor complications. We believe that fixation of suspension suture to the iliopectineal ligament can favorably influence long-term results of needle suspension in the treatment of female stress urinary incontinence.