title: Intra-operative introital ultrasound in Burch colposuspension reduces post-operative complications.
abstract: OBJECTIVE
  To determine the effect of intra-operative monitoring of bladder neck elevation on cure rate and post-operative complications in patients undergoing colposuspension.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  Urogynaecology units, university hospitals.
  
  
  METHODS
  Ninety women operated on for genuine stress urinary incontinence.
  
  
  METHODS
  The topography of the bladder neck and proximal urethra was assessed with pre-, intra- and post-operative introital ultrasound. These measurements were repeated during follow up for up to 48 months after surgery. Burch colposuspension of the bladder neck was performed under intra-operative introital ultrasound control, with reference to the patients' individual pre-operative ultrasound, to achieve a vertical height correction of 1-10 mm.
  
  
  METHODS
  Mid-term surgical outcome and post-operative complications.
  
  
  RESULTS
  Ninety patients underwent colposuspension and 50 (56%) completed 48 months of follow up; 85 women (94%) were objectively continent at 12-month follow up and 42 of 50 (82%) at 48-month follow up. Surgical elevation of the bladder neck resulted in a median intra-operative elevation of 9 mm (7 mm at 48 months). All post-operative measurements demonstrated a significant decrease in linear dorsocaudal movement of the bladder neck during straining (P < 0.001). Funnelling and hypermobility were still decreased 48 months after incontinence surgery (P < 0.001). Voiding difficulty and urgency were uncommon and associated with evidence of funnelling and hypermobility.
  
  
  CONCLUSIONS
  Intra-operative introital ultrasound standardises Burch colposuspension and thus might help to avoid overelevation and associated post-operative complications such as voiding difficulties and de novo urge incontinence without compromising the success of the operation.
authors.affiliation: Department of Obstetrics and Gynaecology, Georg-August-University, Goettingen, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Viereck
authors.forename: Werner
authors.initials: W
authors.lastname: Bader
authors.forename: Thomas
authors.initials: T
authors.lastname: Krauss
authors.forename: Miriam
authors.initials: M
authors.lastname: Oppermann
authors.forename: Annett
authors.initials: A
authors.lastname: Gauruder-Burmester
authors.forename: Reinhard
authors.initials: R
authors.lastname: Hilgers
authors.forename: Reinhard
authors.initials: R
authors.lastname: Hackenberg
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hatzmann
authors.forename: Günter
authors.initials: G
authors.lastname: Emons
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods; D001743:Urinary Bladder / Q000000981:diagnostic imaging* / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000000981:diagnostic imaging / Q000601:surgery*; D014621:Vagina / Q000601:surgery*