title: Obstruction after Burch colposuspension: a return to retropubic urethrolysis.
abstract: We compare our postoperative outcomes of a vaginal vs abdominal urethrolysis after an obstructed Burch colposuspension. We performed a retrospective review of all women who had undergone a Burch urethrolysis from 1997 through 2003. Data collected included pelvic examination, cystoscopic and urodynamic findings, surgical morbidity, and pre- and postoperative urogynecologic symptomatology. Sixteen women underwent Burch urethrolysis. Preoperative symptoms were obstructive in 6, overactive in 2, and both (obstructive/overactive) in 8. All had an acute retropubic angulation of the urethral axis as well as a retropexed urethra that prohibited sagittal rotation of a rigid cystoscope. Seventy-eight percent of the women with urodynamic information met urodynamic criteria for urethral obstruction. Average follow-up was 7 months, and of those undergoing a vaginal urethrolysis, three out of seven (43%) had resolution of their obstructive or overactive symptoms postoperatively. In contrast, seven out of nine women (78%) who underwent a retropubic urethrolysis had relief of their obstructive or overactive bladder symptoms. In our cohort study, an abdominal retropubic urethrolysis was more successful in relieving urethral obstruction than a vaginal urethrolysis.
authors.affiliation: Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Anger
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Amundsen
authors.forename: George D
authors.initials: GD
authors.lastname: Webster
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D014524:Urethral Obstruction / Q000628:therapy*; D014621:Vagina / Q000601:surgery