The Burch colposuspension for recurrent urinary stress incontinence following retropubic continence surgery.

摘要

OBJECTIVE: To evaluate the Burch colposuspension with Cherney incision in women with recurrent urinary stress incontinence after retropubic continence surgery. DESIGN: A retrospective review. PARTICIPANTS: All 53 women had recurrent urinary stress incontinence after retropubic continence surgery with an average of 2.1 (range 1-5) previous failed continence procedures per woman. MAIN OUTCOME MEASURES: Subjective and objective success rates and complications including detrusor instability, voiding difficulties and genital prolapse. RESULTS: Forty-seven women (89%) had no or occasional (< one episode per week) stress or urge incontinence. One woman had persistent stress incontinence and five urge incontinence. Forty-two women (80%) rated their surgery as being highly successful and 38 women (72%) had no urinary leakage due to genuine stress incontinence or detrusor instability on repeat urodynamic evaluation. Three women (6%) developed de novo detrusor instability post-operatively. Two women (4%) had voiding difficulties post-operatively that necessitated the use of intermittent self-catheterisation for at least four months. The median length of follow up was nine months (4-72). In 39 women (73%), marked retropubic fibrosis was found at the time of surgery. CONCLUSIONS: Marked retropubic fibrosis should be expected in women with recurrent stress incontinence after retropubic continence surgery. The Burch colposuspension with the assistance of the Cherney incision and sharp dissection of retropubic fibrosis is an effective and safe procedure for women with this condition.