Burch colposuspension: long-term results and review of published reports.

OBJECTIVES: To review our long-term results with the Burch colpocystourethropexy, compare our results with those in recently published reports, and define factors that may influence the long-term outcome of this procedure. METHODS: A group of 79 patients who underwent Burch colposuspension as modified by Tanagho between January 1985 and January 1991 were studied retrospectively. Preoperative investigation consisted of clinical history, physical examination, cystourethroscopy, multichannel urodynamic evaluation, including pressure-flow studies, and static and dynamic urethral pressure profile analysis. A postal survey was sent to all patients to evaluate their symptoms and the impact on their quality of life. RESULTS: The mean follow-up was 7.6 years (range 5.3 to 10.8). Forty-four percent of patients were considered cured (responders), 25% significantly improved (partial responders), and 31% failures (nonresponders). The success rate was higher among patients who had not undergone previous continence surgery (75%) or hysterectomy (78%) than among those who had previously undergone continence surgery (59%) or hysterectomy (65%). Seventy-five percent of the patients were responders or partial responders if the bladder was stable preoperatively, as opposed to 70% when the bladder was unstable before surgery. Analysis of the postal questionnaire indicated a statistically significant difference in terms of irritative symptoms between the responder and partial responder groups combined and the nonresponder group. CONCLUSIONS: More than two thirds (69.6%) of our patients who underwent a Burch-Tanagho colpocystourethropexy had a favorable long-term outcome (mean 7.6 years). Previously failed continence procedures, unstable bladder preoperatively, and previous or concomitant hysterectomy had a negative influence on the final outcome in the long term from the clinical point of view, even if, statistically, the difference was not significant. The incidence of irritative symptoms and nocturia were significantly higher among nonresponders than among responders and partial responders. More attention paid to these symptoms during the post-operative follow-up should increase the perception of success by the patient after retropubic colpocystourethropexy.

Retropubic cystourethropexy: is it an obstructive procedure?

PURPOSE: We sought to establish whether colpocystourethropexy creates bladder outlet obstruction, as evaluated by pressure-flow studies. MATERIALS AND METHODS: We retrospectively analyzed the records of 50 women. Preoperative evaluation included a detailed questionnaire, physical examination, urine culture, cystourethroscopy and multichannel urodynamic testing. Every patient underwent retropubic colpocystourethropexy according to the Tanagho modification of the original Burch technique. An average of 3 months after the operation clinical evaluation and identical multichannel urodynamic testing were repeated. Preoperative and postoperative urodynamic parameters were compared for each patient and statistical differences were established using Student's 2-tailed t test. RESULTS: No statistically significant difference was demonstrated in static urethral pressure profile parameters and in parameters during the filling phase of the cystometrogram except for cystometric capacity, which decreased after surgery (p = 0.02). In contrast, all 5 pressure-flow parameters analyzed (minimum urethral opening pressure, detrusor pressure at maximum flow, maximum flow, theoretical cross-sectional area and theoretical diameter of the flow rate controlling zone) showed statistically significant differences induced by surgery. Pressure-flow data reported on Schäfer's diagram and on the Abrams-Griffiths nomogram failed to demonstrate urodynamically significant obstruction created by surgery. CONCLUSIONS: Our data suggest that colpocystourethropexy does not create obstruction but, rather, restores pressure-flow conditions to a normal or nearly normal level.

Nephrogenic adenoma of the bladder after kidney transplantation: spontaneous improvement with azathioprine removal; surgical trauma and cytomegalovirus infection as possible etiologic factors.

We report 2 cases of nephrogenic adenoma several years after successful cadaver kidney transplantation. In 1 case the lesion had cytomegalovirus inclusions, and we observed a marked and sustained reduction in the extension of the lesion with cessation of azathioprine. Surgical trauma and cytomegalovirus infections are discussed as etiologic factors. Conservative treatment seemed appropriate.