title: Burch bladder neck suspension for cystocele repair: the necessity of combined vaginal procedures for severe cases.
abstract: BACKGROUND
  Burch operation is an accepted form of bladder neck suspension for small cystoceles. The purpose of the present study was to evaluate the efficacy of Burch repair for severe cystoceles compared with Burch repair along with vaginal procedures.
  
  
  METHODS
  A total of 14 patients with severe cystocele (grade III-IV) treated with open Burch operation were evaluated retrospectively. Of these patients, eight were Burch only and the remaining six underwent combined Burch with vaginal repair (anteroposterior vaginal wall plasty and hysterectomy).
  
  
  RESULTS
  After a mean follow up of 40 months (range 6-80), cystocele recurred in one patient at 1 month, and rectocele became prominent in three patients, including one who also presented uterine prolapse among the Burch-only group. Conversely, all six patients who underwent the combined operation showed no occurrence of cystocele or rectocele. The proportion of patients not failing treatment was significantly higher in the combined operation group than in the Burch-only group. Intermittent self-catheterization was needed in one patient from the combined operation group for 6 months, but all other patients had restored smooth urination within a few weeks after the operation.
  
  
  CONCLUSIONS
  The results suggest that, for severe cystoceles, Burch-only repair is insufficient and combined Burch with vaginal repair should be used to manage various pelvic hypermobility symptoms.
authors.affiliation: Department of Urology, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kanagawa, Japan. sekine@med.teikyo-u.ac.jp
authors.forename: H
authors.initials: H
authors.lastname: Sekine
authors.forename: S
authors.initials: S
authors.lastname: Kojima
authors.forename: K
authors.initials: K
authors.lastname: Igarashi
authors.forename: T
authors.initials: T
authors.lastname: Toyoshima
authors.forename: T
authors.initials: T
authors.lastname: Hayashi
authors.forename: Y
authors.initials: Y
authors.lastname: Shimoji
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D020047:Rectocele / Q000150:complications / Q000601:surgery; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery; D001745:Urinary Bladder Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D013519:Urogenital Surgical Procedures / Q000379:methods*; D014621:Vagina / Q000601:surgery