title: Prevention of genital prolapse following Burch colposuspension: comparison between two surgical procedures.
abstract: Our objective was to evaluate the efficacy of cul-de-sac obliteration in preventing pelvic floor anatomical defects formation following Burch colposuspension. We evaluated 441 patients who had undergone Burch colposuspension. The patients were divided into two groups: group A (132 patients) who underwent Burch colposuspension only, and group B (309 patients) who had had a concomitant cul-de-sac obliteration. Cul-de-sac obliteration was performed using two different techniques, the Moschocowitz procedure in 131 patients, and approximation of the sacrouterine ligaments in 178 patients. The follow-up period was 8.6 years (range 3-16). In total we found 43/441 (9.7%) postoperative anatomical defects. Obliteration of the cul de sac significantly (P<0.0001) reduced the formation of anatomical defects compared to Burch colposuspension. In a comparison of the two surgical procedures for cul-de-sac obliteration, the approximation of the sacrouterine ligaments was significantly more effective than either the Moschcowitz procedure (P<0.001) or the Burch colposuspension alone (P<0.001). The Moschcowitz procedure reduced the formation of anatomical defects to 15/131 (11.4%) compared to Burch colposuspension only (25/132; 18.9%), but statistically the difference was insignificant. The time of anatomical defect detection was significantly reduced after cul-de-sac obliteration: 2 years 6/25 (24%) in group A compared to 1/8 (5.5%) in group B (P<0.01). After 5 years the detection rate was 64% (16/25) and 22.2% (4/18) respectively (P<0.01). It was concluded that cul-de-sac obliteration using approximation of the sacrouterine ligaments significantly reduced the incidence of anatomical defect formation following Burch colposuspension. A long follow-up period is needed to evaluate the truce incidence.
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Zerifin, 70300, Israel. IBukovsky@asaf.health.gov.il
authors.forename: R
authors.initials: R
authors.lastname: Langer
authors.forename: Y
authors.initials: Y
authors.lastname: Lipshitz
authors.forename: R
authors.initials: R
authors.lastname: Halperin
authors.forename: M
authors.initials: M
authors.lastname: Pansky
authors.forename: I
authors.initials: I
authors.lastname: Bukovsky
authors.forename: D
authors.initials: D
authors.lastname: Sherman
mesh_terms: D004312:Douglas' Pouch / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control*; D013997:Time Factors; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014596:Uterine Prolapse / Q000517:prevention & control*