The mechanism of successful colposuspension in genuine stress incontinence.
BACKGROUND
Colposuspension (Burch procedure) is one of the most effective surgical procedures for the cure of genuine stress incontinence in women. The aim of the current study was to understand the mechanism of successful colposuspension for treatment of this condition.


METHODS
Thirty-five patients with primary genuine stress incontinence underwent colposuspension. Preoperative investigation included detailed history taking, urinalysis, pelvic floor relaxation assessments, one-hour pad test, Q-tip test, urodynamic study and perineal ultrasound urethrocystography. Follow-up results were estimated after one year.


RESULTS
Twenty-five (71.4%) patients were completely cured; four (11.4%) patients showed significant improvement and six (17.1%) had recurrence of incontinence. The overall success rate was 82.9%. The complication rate was 20%. Urodynamic data revealed a significant increase in the maximal stress urethral closure pressure and proximal urethral transmission ratios. Perineal ultrasound urethrocystography and Q-tip test revealed a significant anatomic correction in bladder neck descent.


CONCLUSIONS
This study confirmed that surgical cure of urinary incontinence can be achieved by restoration of the vesical neck from a dependent position in the pelvis to a position high behind the symphysis pubis, with subsequent improved pressure transmission ratios.
Chen
H Y
HY
Department of Obstetrics and Gynecology, China Medical College Hospital, Taichung, Taiwan, ROC.
Lin
W C
WC
Tsai
H D
HD
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D014550:Urinary Incontinence, Stress / Q000601:surgery*