Multichannel Urodynamics for Laparoscopic Burch and Pelvic Vault Repairs
This is a 1-year preliminary report of a 5-year study. Forty-six women with genuine stress incontinence (GSI) were evaluated with multichannel urodynamics before laparoscopic Burch repair and 1 year postoperatively. Reports conclude that as many as 18% of patients develop enteroceles or rectoceles in the first 5 years after Burch repair. To see if prophylactic posterior suspension could prevent this delayed complication, all women had at least a modified culdoplasty. If paravaginal defects, rectoceles, or enteroceles were present, these were also repaired laparoscopically. All patients had a quality of life questionnaire, 24-hour urolog, transperineal ultrasound, cystourethroscopy, cough stress test, and multichannel urodynamics. At 6 weeks they all had a negative ultrasound, cough stress test, and cystometrogram. At 1 year the complete evaluation was repeated. Five women were lost to follow-up. Four of 41 patients had recurrent GSI. One patient had a grade 1 cystocoele with no other signs of pelvic vault prolapse. These are cure rates of 91% and 98% for GSI and pelvic vault prolapse, respectively. The urodynamic studies appear to be comparable with those reported in laparotomy Burch repairs. These findings are encouraging for laparoscopic procedures, but they are short term and it is essential that the patients be followed for 5 years for the data to be clinically relevant.
Ross
JW
Center Reproductive Medicine and Laparoscopic Surgery, 254 San Jose Street, Salinas, CA 93901.