Long-term results after Burch colposuspension

Abstract

Foley Catheterization After Vaginal Plastic Surgery 7. Schiotz HA. Urinary Tract infections and bacteriuria after gynecological surgery. Experience with 24-hour Foley catheterization, lnt Urogynecol J 1994;5:345-348 8. Schi0tz HA. Pelvic laparotomy and 24-hour Foley catheterization. Acta Obstet Gynecol Scand (submitted) 9. Schi0tz HA. Voiding after gynecologic surgery: experience with 24-hours Foley catheterization. Int UrogynecolJ 1994;5:15-18EDITORIAL COMMENT: From this randomized prospective study it would appear that the time of catheter removal after anterior colporrhaphy with or without other repairs, or a Manchester procedure, is not important as regards the 161 incidence of either infection or retention. No prophylactic antibiotics or cholinergic medications were used. One unanswered question is the degree of retention manifested by these patients. The author defines retention as ~the need for intermittent catheterization at least once' if the patient was 'distressed or a bladder volume >500 ml was suspected'. We are not told what the catheterized volumes were. If the postvoid residual is defined as the inability to void with a truly full bladder during the postoperative period, the term retention is appropriate. However, without a knowledge of the retained volume or the actual bladder capacity it is difficult to interpret the true incidence of retention. Am J Obstet Gynecol 1994; 171:647-652Follow-up evaluation was performed on 87 women who had had Burch colposuspension for stress urinary incontinence over the previous 5 years. All patients met strict criteria for surgery, including stress incontinence, mild pelvic relaxation, hypermobility of the urethrovesical junction and absence of detrusor instability. Preoperative evaluation was extensive and objective, as was the follow-up examination. The technique used two non-absorbable sutures on either side of the urethrovesical junction. Success of surgery was 42/52 patients (80.8%) with no prior surgery, 20/24 (83.3%) for those having one prior operation, and 9/11 (81.8%) for those having had two previous operations. Postoperative studies shows a longer urethral functional length at rest, increased urethral functional length at stress, and increased maximum urethral closure pressure at stress in successful patients. There was a decrease in maximum urethral closure pressure at rest and at stress, and in pressure transmission in the unsuccessful patients.

The Miniarc® sling system in the treatment of female stress urinary incontinence

“…Another possible contributing factor is neurogenic damage. Established tape procedures are also known to have poorer results in patients with a low-pressure urethra (17)(18)(19)(20), Outcome was poorer in women with prior incontinence surgery compared with the women who underwent the MiniArc® procedure as a primary intervention. We did not include a control group because we wanted each patient to have a choice to opt for any of the conventional treatments after comprehensive information about the new sling procedure.…”

Opening detrusor pressure and the influence of age on success following colposuspension

“…Patient characteristics and their association with failed continence surgery have been previously examined [Stanton et al, 1978;Feyereisel et al, 1994;Hutchings et al, 1998] and lower operative success rates found with increasing age [Stanton et al, 1978;Hutchings et al, 1998], previous incontinence surgery [Stanton et al, 1978], and pre-operative detrusor overactivity [Stanton et al, 1978]. In this series, women with pre-operative detrusor overactivity were excluded and only one had undergone previous retropubic surgery.…”

“…Although no standardised de¢nition exists, MUCP < 20 cmH 2 O is taken to indicate urethral sphincter incompetence [McGuire et al, 1993] and age over 50 years has been identi¢ed as a predictor of intrinsic sphincter de¢ciency [Horbach and Ostergard, 1994]. MUCP 22 cmH 2 O is more common after unsuccessful continence surgery [Weil et al, 1984] and a lower than expected MUCP for a given age or a post-operative MUCP < 20 cmH 2 O are associated with recurrence of symptoms and diminished surgical success [Feyereisel et al, 1994;Monga and Stanton, 1997]. In the resting state, MUCP is largely produced by the intramural striated muscle of the urethral sphincter and maximally located at the level of the pelvic £oor.…”

Morbidity of incontinence surgery in women over 70 years old: a retrospective cohort study

“…14,15 However, the effect of oestrogen deficiency rather than age per se must be considered in respect of the data in these studies because the majority of women in the postmenopausal groups were under 70. The effect on increasing age as a continuous variable has been studied in many papers reporting surgical outcomes, but the specific categorisation of patients into an 'elderly category' as we have done has rarely been used.…”