[Modified sacrocolpopexy combined with a Burch procedure for recurrent stress urinary incontinence].
OBJECTIVE
Surgical procedures for the treatment of stress urinary incontinence (SUI) due to pelvic organ prolapse have specific relapse rates, especially with regard to long-term results. The aim of this study was to investigate the efficacy of a combined surgical technique: sacrocolpopexy combined with a Burch procedure - in particular as an option for previously operated patients.


METHODS
From 9/2001 to 8/2004, 33 patients (mean age: 65 years) underwent a modified sacrocolpopexy combined with a Burch procedure. Thirty-six (93 %) patients had previous pelvic operations, nineteen (58 %) of them had failure of prior prolapse surgery. All women presented with urinary incontinence, cystocele and vault prolapse. SUI was classified grade II to III in 67 % (n = 22) cases. Grade II - III genital prolapse was associated in 88 % (n = 29) of the patients. They were screened by preoperative video-urodynamics. Surgery consisted of a Burch procedure and modified abdominal sacrocolpopexy. The mean follow-up was 18 months (range: 10 - 30 months). Follow-up investigations included a symptom score and an urogynaecological examination. A subgroup of ten patients had additional postoperative video-urodynamics.


RESULTS
In all cases the operative procedure was performed successfully. During the follow-up 73 % (n = 24) of the patients were dry, another 18 % (n = 6) showed significant improvement. The number of diurnal/nocturnal micturitions decreased significantly from 9.4 to 6.9 (p < 0.005) and 2.2 to 1.1 (p < 0.005), respectively. The daily use of incontinence pads, as well as the amount of residual urine, decreased significantly from n = 5.1 to n = 1.1 (p < 0.005) and 60 mL to 6.0 mL (p < 0.005). Postoperative urodynamics showed that the bladder function remained unaffected by the procedure regarding de novo detrusor overactivity.


CONCLUSIONS
After a mean follow-up of 18 months the modified sacrocolpopexy combined with a Burch procedure, as described above, is a promising technique for highly morbid and preoperated patients.
Seif
C
C
Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel. cseif@urology.uni-kiel.de
Hamann
M
M
Braun
P-M
PM
Jünemann
K P
KP
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012447:Sacrum / Q000601:surgery; D013526:Surgical Mesh; D013536:Suture Techniques; D001745:Urinary Bladder Diseases / Q000503:physiopathology / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics / Q000502:physiology; D014596:Uterine Prolapse / Q000503:physiopathology / Q000601:surgery*; D014621:Vagina / Q000601:surgery