A randomized comparison of vesicourethral function after laparoscopic hysterectomy with and without vaginal cuff suspension.
OBJECTIVE
To compare vesicourethral function following laparoscopic hysterectomy (LH) with and without vaginal cuff suspension.


METHODS
Prospective study (Canadian Task Force classification I).


METHODS
Tertiary teaching hospital.


METHODS
Sixty-eight women scheduled for LH randomly assigned to either LH without vaginal cuff suspension (LH group; n = 36) or LH with suspension (LHS group; n = 32).


METHODS
All subjects received urinalysis, pelvic examination, Q-tip test, introital ultrasonography, and a urinary questionnaire before and 6 months after surgery.


RESULTS
The prevalence of stress urinary incontinence (SUI) decreased significantly from 46.9% (n = 15) preoperatively to 18.8% (n = 6) postoperatively in the LHS group (p = .022), but this was not so in the LH group. Similarly, the mean straining urethral angle and the number of women exhibiting bladder neck (BN) hypermobility significantly decreased after surgery in only the LHS group (p <.05; p <.01, respectively). During straining, the postoperative position of the BN localized more dorsally (p <.01), and its ventral mobility decreased significantly (p <.01) in the LH group. In the LHS group, significant postoperative reduction was found in both ventral and caudal movements of the BN during stress (p <.01), causing a more cranial and dorsal position of the BN (p <.01).


CONCLUSIONS
Laparoscopic hysterectomy with cuff suspension strengthens the traction effect on the endopelvic fascia, reducing both BN mobility during stress and the chance of SUI. However, simply performing a cuff suspension is not adequate for the treatment of severe SUI.
Long
Cheng Yu
CY
Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Liu
Cheng Min
CM
Wu
Tung Pi
TP
Hsu
Shih Cheng
SC
Chang
Yu
Y
Tsai
Eing Mei
EM
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005831:Genital Diseases, Female / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D013526:Surgical Mesh; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000517:prevention & control*; D014563:Urodynamics; D014596:Uterine Prolapse / Q000517:prevention & control* / Q000601:surgery