Burch colposuspension: Our long-term results

Abstract

Introduction: The International Continence Society (ICS) defined stress urinary incontinence as "involuntary leakage on effort or exertion, or on sneezing or coughing". Urinary incontinence occurs frequently, and affects the life quality of millions of people all around the world. The prevalence of incontinence in women is reported between 4.5% and 53%. Various factors have been shown to be associated with an increased prevalence of urinary incontinence, for example over-weight, gynecological operations, chronic respiratory illness, obstipation, jobs involving heavy lifting and physical exercise, and parity. A wide variety of surgical techniques have been devised for the treatment of stress urinary incontinence. Mechanism of these procedures is providing suburethral support or stabilizing the urethra. However, only the Burch colposuspension and autologous fascial pubovaginal sling have sufficient studies which have been documented long-term efficacy. Success rates are extremely well in short-term follow up, however these rates are gradually decreasing with longer follow-up. We aimed to review long-term results with the Burch colpocystourethropexy which were performed in our clinic. Materials and Methods: A total of 67 patients who underwent Burch colposuspension were studied retrospectively from a group of 98 patients who underwent anti-stress incontinence procedure between January 1992 and January 2001 in our clinic. Fifty-seven (85.1%) patients were included in this study. Preoperative investigation consisted of detailed medical history, physical examination, 1 hour pad test, Q-type test, and cystourethroscopy in some patients. Additionally, cystometric studies were performed on 53 (79.1%) patients with 6 channel urodynamic equipment. The patients were operated with modified Burch colpocystourethropexy technique as described by Tanagho. Postoperatively, patients were investigated for lower urinary tract symptoms and incontinence in face-to-face interviews and were also assessed by 1 hour pad test and physical examination. Results: Patients' mean age was 50.8±11.9 years. The mean follow-up was 5.7±3.4 years. Preoperatively, 22 of the cases (38.6%) had 1stdegree and 13 had (22.8%) 2nd degree cyctocele. Besides, 1st degree rectocele was observed in 10 cases (17.5%) and 2nd degree in 8 cases (14.0). Idiopathic detrusor over activity was detected in 10 of 53 patients and cystometry was performed before the operation. Additionally, eight patients (14%) had had failed anti stress urinary incontinence surgery in medical history. The average of pad test was 11.0±1.1 g and 2.6±0.6 g (p<0.0001) in preoperative and postoperative patients, respectively. Forty-one (71.9%) patients were considered as cured, 4 (7%) significantly improved (partial responders), 8 (14%) failures, and 4 (7%) had urge incontinence. One of the urge incontinent cases occurred de-novo and the others were observed as continuation of preoperative complaints. However, two of these patients were operated before urodynamics. Only one case (1.8%) that could not void in early postoperative period was treated by transurethral catheter for three weeks and no complication was observed later. Conclusion: More than two thirds of our patients who underwent a Burch colposuspension had a favorable long-term outcome. The evidence available indicates that open retropubic colposuspension is the most effective treatment modality for stress urinary incontinence especially in the long term. Additionally, this procedure has higher success rates and is more cost-effective than other procedures in our country. For these reasons, Burch colposuspension maintains its reliability as a safe procedure.

Özet

Stres tipi idrar kaçırma "Uluslararası Kontinans Topluluğu" (ICS) tarafından bir güç harcanması, egzersiz, hapşırma veya öksürmekle idrar kaçırma olarak tanımlanmıştır. Stres tipi idrar kaçırma (STİK) özellikle orta ve ileri yaş grubu kadınlarda yaygın bir sorundur. Burch tipi kolposüspansiyon STİK tedavisinde uzun dönem başarı oranlarının iyi olması nedeniyle yaygın kabul gören tekniklerden birisidir. Bu çalışmada kliniğimizde gerçekleştirilen Burch tipi kolposüspansiyon ameliyatlarının uzun dönem sonuçlarının gözden geçirilmesi amaçlanmıştır. Ocak 1992-Ocak 2001 yılları arasında kliniğimizde antiinkontinans cerrahisi uygulanan 98 olgudan Burch tipi kolposistoüretropeksi ameliyatı yapılan toplam 67 olgu geriye dönük olarak incelendi. Ameliyat sonrası yüz yüze görüşülerek olgular alt üriner sistem semptomları ve idrar kaçırma yönünden sorgulandı. 1 saatlik ped testi, fizik inceleme ile değerlendirildi. Çalışmaya alınan 57 (%85.1) olgunun yaş ortalaması 50.8±11.9 yıl, ameliyat sonrası ortalama takip süresi ise 5.7±3.4 yıl idi. Ameliyat öncesi sistometri yapılan olguların 10'unda (%18.9) açıklanamayan detrüsör aşırı aktivitesi saptandı. Ayrıca 8 olgunun (%14) başarısız anti stres tipi idrar kaçırma cerrahisi öyküsü vardı. Ped testi ortalamaları ameliyat öncesi 11.0±1.1 gr, sonrası ise 2.6±0.6 gr (p<0.0001) olarak bulundu. Ameliyat sonrası dönemde 41 (%71.9) olguda tam düzelme, 4 (%7) olguda kısmi düzelme, 8 (%14) olguda şikayetlerin devamı ve 4 (%7) olguda ise sıkışma tarzında idrar kaçırma saptandı. Burch tipi kolposüspansiyon yapılan olgularımızın uzun dönem başarı oranları yüksektir. Ayrıca diğer prosedürlere göre ülkemizdeki düşük maliyeti ve yüksek başarı yüzdesi nedenleri ile Burch tipi kolposüspansiyon güvenilir bir prosedür olarak yerini korumaktadır.