A comparison of bladder neck movement and elevation after tension-free vaginal tape and colposuspension.
OBJECTIVE
To compare elevation and movement of the bladder neck after tension-free vaginal tape and open Burch colposuspension, using transperineal ultrasound.


METHODS
Pospective, non-randomised study using pre- and post-operative transperineal ultrasound of the bladder neck.


METHODS
Tertiary referral urogynaecology unit at a London teaching hospital.


METHODS
Thirty consecutive women who underwent tension-free vaginal tape or colposuspension for primary genuine stress incontinence between March 1998 and June 1999.


METHODS
Women underwent transperineal ultrasound of the bladder neck prior to and three to four weeks after surgery.


METHODS
Bladder neck elevation, angle and movement in relation to the pubic symphysis.


RESULTS
For both tension-free vaginal tape and colposuspension the post-operative bladder neck angles at rest and valsalva were more acute than pre-operatively. The post-operative linear movement on valsalva was less than pre-operatively. For colposuspension the rotational movement on valsalva was significantly less post-operatively, but for tension-free vaginal tape there was only a trend towards less post-operative rotational movement. Post-operative angles and movement were significantly less for colposuspension. The resting bladder neck position was elevated significantly more by colposuspension.


CONCLUSIONS
Both tension-free vaginal tape and colposuspension decrease bladder neck angles at rest and valsalva, linear movement on valsalva and elevate the bladder neck. The colposuspension causes significantly more change than the tension-free vaginal tape. This suggests the mechanism of continence for the tension-free vaginal tape is less dependent on bladder neck change than the colposuspension.
Atherton
M J
MJ
Department of Obstetrics and Gynaecology, St George's Hospital, Medical School, London.
Stanton
S L
SL
D005260:Female; D006801:Humans; D008875:Middle Aged; D009068:Movement; D011446:Prospective Studies; D013536:Suture Techniques; D018084:Ultrasonography, Interventional; D001743:Urinary Bladder / Q000502:physiology / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014621:Vagina / Q000601:surgery*