Stress Urinary Incontinence And Posterior Bladder Suspension Defects: Results Of Vaginal Repair Versus Burch Colposuspension

Abstract

Vaginal repair has been recommended in cases of stress urinary incontinence and posterior bladder suspension defect diagnosed by colpocysto-urethrography. Thirty-eight women with stress urinary incontinence and posterior suspension defect have been treated. First, 19 women underwent a vaginal repair. In a second period, another 19 consecutive patients had a colposuspension a.m. Burch. The patients have been evaluated 6 months postoperatively and at a long-term follow-up. No significant difference was found postoperatively in the frequency of symptoms and signs of stress incontinence, either after 6 months or at the long-term follow-up. A significantly smaller frequency of genital prolapse was found in the colposuspension group at long-term follow-up. No side effects such as frequency, urgency or bacteriuria were evident in the group treated by colposuspension. With reservation to the non-randomized allocation, it may be concluded that a radiographic distinction between anterior and posterior bladder suspension defects in choosing the surgical approach is unnecessary.

Long-Term Results of Burch Colposuspension

“…Studies describing results over longer periods are rare. Success rates after surgery seem to be inversely related to the length of postoperative follow-up [5,6,8]. In the present Demirci/Yucel/Eren/Alkan/Demirci/ Yıldırım study, the overall cure rate was 87.7% for 1.5 years and 77.4% for 4.5 years of follow-up.…”

“…However, 5 years after the procedure only 75.8% of the women were symptom-free. Thunedborg et al [6] reported a complete cure rate of 78.6% for 6 years, Kinn [9] reported 78% for 5 years, Eriksen et al [8] reported 67% for 5 years, Lebret et al [10] reported 64% for 5 years, Kjolhede and Ryden [11] reported 63% for 6 years and Christensen et al [12] reported 33%. These earlier and long-term results are comparable with our results.…”

Assessing observational studies of medical treatments

“…Failure rates were used to compute odds ratios not computed by the original studies. For some studies the success rates and odds ratios in the primary studies [29-32] differed from those reported by Ioannidis et al [13] or the meta-analysis [28]. When there was a discrepancy, we used the rates reported in the primary studies.…”

“…Confounding was more likely in two studies because subjects on one treatment were treated several years previously compared with subjects on another. Confounding was also more likely in other studies (the majority of trials of labor and surgery for incontinence and half the studies of early discharge [32,33]) because treatment was allocated on the basis of patient characteristics likely to influence the possibility of treatment failure. Confounding may have been less likely if the physicians treating the patients used only one procedure.…”

“…There was evidence of obvious confounding that was not taken into account in three treatment comparisons: 1) influence of anticoagulants on survival of myocardial infarction (historical controls treated several years earlier [45-47] and anticoagulants preferentially given to younger patients and patients at lower risk for other reasons [48,49]) 2) quinidine for the treatment of arrhythmias (significantly higher [50,51] rates of valvular heart disease in the quinidine group), and 3) colposuspension versus anterior colporrhaphy (substantially and significantly higher rates in the colposuspension group of severe pre-surgery incontinence [52]). [32,34] In no study showing obvious confounding did the authors assess or adjust for confounding, or even raise it as a concern.…”