Cistouretropexia laparoscópica tipo Burch para el tratamiento de la incontinencia urinaria de esfuerzos: seguimiento a largo plazo / Laparoscopic Burch colposuspension for the treatment of stress urinary incontinence

Objetivos: Conocer las complicaciones, las tasas de cura subjetiva y valoración con el índice de severidad de Sandvik a largo plazo de pacientes en quienes se realizó cistouretropexia laparoscópica tipo Burch para la corrección de su incontinencia urinaria de esfuerzo (IUE). Método: Análisis descriptivo, retrospectivo. Nivel de evidencia III. Se incluyeron las pacientes con diagnóstico de IUE tipo Blaivas IIB, a quienes se les practicó Burch laparoscópico en la Clínica del Prado y Profamilia Medellín, entre los años 2003 y 2007. Las variables principales a evaluar fueron edad, tiempo quirúrgico, cura subjetiva, índice de severidad de Sandvik y complicaciones. Resultados: Se analizaron 72 pacientes con promedio de edad de 46,57 +/- 9,54 años. El tiempo promedio de seguimiento fue de 24,4 meses (rango: 9,0-55,8 meses). El tiempo quirúrgico promedio fue de 79,83 minutos (rango: 44-160 minutos). Refirieron cura subjetiva 56 pacientes (77,8 por ciento). El índice de severidad de Sandvik muestra que a largo plazo 56,9 por ciento pacientes estaban secas con remisión completa de los síntomas y el 13,8 por ciento pacientes tenían pérdidas leves. Conclusiones: El Burch laparoscópico es una opción efectiva para el manejo de la incontinencia urinaria de esfuerzo tipo Blaivas IIB. Provee tasas de curación subjetiva a largo plazo similares a otros tipos de tratamiento. Es una opción más a tener en cuenta en el manejo de la IUE, en especial aquellas pacientes con patologías asociadas que se beneficien del abordaje por laparoscopia.

Objectives: To describe the subjective cure rate, the score of the Sandvik test and the complications after laparoscopic Burch in patients with stress urinary incontinence (SUI). Methods: Prospective descriptive study. We included all patients diagnosed with SUI Blaivas type IIB, and operated on by laparoscopy in two reference institutions between 2003 and 2007. Results: We analyzed 72 patients with an average age of 46.57 +/- 9.54 years. The average follow-up was 24.4 months, with a minimum of 9 and a maximum of 55.8. The average operating time in 29 patients in which we only performed laparoscopic Burch with or without colporrhaphy was 93.7 minutes (55-180 minutes); 56 patients (77.8 percent) reported subjective cure. The Sandvik's severity index found 56.9 percent dry patients and 13.8 percent with mild losses. Conclusion: The laparoscopic management may be useful in some patients, especially those who will be carried to laparoscopy by some other indication. Subjective cure rates are similar to other types of surgery.

An unusual foreign body in the bladder 5 years after a laparoscopic burch colposuspension / 대한산부인과학회지

Stress urinary incontinence is the predominant symptom in young and middle-aged women. Stress urinary incontinence is not a life-threatening disease but can lead to discomfort, which can also limit the social and sexual activities of women. Lately TOT operation is performed in most cases of stress urinary incontinence. But Burch colposuspension had been one of successful operations for genuine stress incontinence until TOT procedure was performed. Burch colposuspension has significant morbidity such as bleeding, infection and wound hematoma, and subsequent complications including voiding difficulty, de novo detrusor instability, recurrent urinary tract infection and uterovaginal prolapse. In this case, Delayed migration of the suture and bolster after an endoscopic Burch colposuspension across tissue planes, with subsequent erosion into the bladder, is uncommon. We report an unusual complication 5 years after Burch operation. It was an intravesical foreign body granuloma caused by suture material.

Osteitis Pubis after Laparoscopic Burch Colposuspension Using Tacker(R) / 대한비뇨기과학회지

Osteitis pubis is a noninfectious, painful, inflammmatory condition affecting the periosteum, cartilage, and ligaments of the symphysis pubis. It has been associated with urologic and gynecologic procedures, pregnancy and rheumatologic disorders. Despite seven decades of speculation, its pathogenesis, diagnostic criteria, natural history and optimal therapy for osteitis pubis remain controversial. We had experienced two cases of osteitis pubis after laparoscopic Burch colposuspension using prolene mesh and Tacker(R). All cases of osteitis pubis were treated with conservative managements.

Laparoscopic Burch Colposuspension (Transperitoneal Approach) / 대한비뇨기과학회지

PURPOSE: The Burch bladder neck suspension is a effective treatment for stress urinary incontinence due to hypermobility. To assess the safety, effectiveness and potential benefits of the transperitoneal laparoscopic Burch colposuspension. MATERIALS AND METHOD: We assessed the short-term result of 15 patients who underwent a laparoscopic Burch colposuspension with transperitoneal approach. All patients had stress incontinence with bladder neck hypermobility and no cystocele and rectocele. The 14 patients had coexisting disorder(uterine myoma 11, ovarian cyst 2, carcinoma in situ 1), so concomitant operation was performed 14 cases(laparoscopic assisted vaginal hysterectomy 12, laparoscopic assisted ovarian cystectomy. RESULTS: In 15 patient who underwent the laparoscopic procedure, continent in 11(73%), improved in 1 (6%) and failed in 3(20%) with mean follow-up of 14 months (range 6-18). The mean operation time was 81 minutes(range 70-120), mean postoperative hospital stay was 4.8 days(range 3-7). CONCLUSIONS: Laparoscopic colposuspension with the transperitoneal approach is a reasonable alternative in treating stress urinary incontinence, especially when the patients have previous properitoneal or lower abdominal surgery or concomitant operation for coexisting disease. Early results are similar to those of open and needle suspension techniques, although longer follow-up is necessary to determine longterm efficiency.