Intra-operative introital ultrasound in Burch colposuspension reduces post-operative complications.
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.
Viereck
Volker
V
Department of Obstetrics and Gynaecology, Georg-August-University, Goettingen, Germany.
Bader
Werner
W
Krauss
Thomas
T
Oppermann
Miriam
M
Gauruder-Burmester
Annett
A
Hilgers
Reinhard
R
Hackenberg
Reinhard
R
Hatzmann
Wolfgang
W
Emons
Günter
G
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*