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International Urogynecology Journal

, Volume 17, Issue 5, pp 455–459 | Cite as

Obstruction after Burch colposuspension: a return to retropubic urethrolysis

  • Jennifer T. Anger
  • Cindy L. Amundsen
  • George D. WebsterEmail author
Original Article

Abstract

We compare our postoperative outcomes of a vaginal vs abdominal urethrolysis after an obstructed Burch colposuspension. We performed a retrospective review of all women who had undergone a Burch urethrolysis from 1997 through 2003. Data collected included pelvic examination, cystoscopic and urodynamic findings, surgical morbidity, and pre- and postoperative urogynecologic symptomatology. Sixteen women underwent Burch urethrolysis. Preoperative symptoms were obstructive in 6, overactive in 2, and both (obstructive/overactive) in 8. All had an acute retropubic angulation of the urethral axis as well as a retropexed urethra that prohibited sagittal rotation of a rigid cystoscope. Seventy-eight percent of the women with urodynamic information met urodynamic criteria for urethral obstruction. Average follow-up was 7 months, and of those undergoing a vaginal urethrolysis, three out of seven (43%) had resolution of their obstructive or overactive symptoms postoperatively. In contrast, seven out of nine women (78%) who underwent a retropubic urethrolysis had relief of their obstructive or overactive bladder symptoms. In our cohort study, an abdominal retropubic urethrolysis was more successful in relieving urethral obstruction than a vaginal urethrolysis.

Keywords

Female urology Bladder outlet obstruction Urethrolysis Urodynamics Burch urethropexy 

Notes

Acknowledgements

This work was supported in part by the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust and in part by the Kidney and Urology Foundation of America, Inc.

References

  1. 1.
    Carr LK, Webster GD (1996) Bladder outlet obstruction in women. Urol Clin North Am 23(3):385–391CrossRefPubMedGoogle Scholar
  2. 2.
    Scarpero HM, Dmochowski RR, Nitti VW (2003) Repeat urethrolysis after failed urethrolysis for iatrogenic obstruction. J Urol 169(3):1013–1016CrossRefPubMedGoogle Scholar
  3. 3.
    Amundsen CL, Guralnick ML, Webster GD (2000) Variations in strategy for the treatment of urethral obstruction after a pubovaginal sling procedure. J Urol 164:434CrossRefPubMedGoogle Scholar
  4. 4.
    Sweat SD, Itano NB, Clemens JQ, Bushman W, Gruenenfelder J, McGuire EJ, Lightner DJ (2002) Polypropylene mesh tape for stress urinary incontinence: complications of urethral erosion and outlet obstruction. J Urol 168(1):144–146CrossRefPubMedGoogle Scholar
  5. 5.
    Maher C, Dwyer P, Carey M, Gilmour D (1999) The Burch colposuspension for recurrent urinary stress incontinence following retropubic continence surgery. Br J Obstet Gynaecol 106:719–724PubMedGoogle Scholar
  6. 6.
    Alcalay M, Monga A, Stanton SL (1995) Burch colposuspension: a 10–20 year follow-up. Br J Obstet Gynaecol 102:740–745PubMedGoogle Scholar
  7. 7.
    Dunn JS Jr, Bent AE, Ellerkman M, Nihira MA, Melick CF (2004) Voiding dysfunction after surgery for stress incontinence: literature review and survey results. Int Urogynecol J 15:25–31CrossRefGoogle Scholar
  8. 8.
    Eriksen BC, Hagen B, Eik-Nes SH, Molne K, Mjolnerod OK, Romslo I (1990) Long-term effectiveness of the Burch colposuspension in female urinary stress incontinence. Acta Obstet Gynecol Scand 69(1):45–50PubMedCrossRefGoogle Scholar
  9. 9.
    Raz S, Sussman AEM, Erickson DB, Bregg KJ, Nitti VW (1992) The Raz bladder neck suspension: results in 206 patients. J Urol 148(3):845–850PubMedGoogle Scholar
  10. 10.
    Spencer JR, O'Conor VJ Jr, Schaeffer AJ (1987) A comparison of endoscopic suspension of the vesical neck with suprapubic vesicourethropexy for treatment of stress urinary incontinence. J Urol 137(3):411–415PubMedGoogle Scholar
  11. 11.
    Cross CA, Cespedes DR, McGuire EJ (1998) Our experience with pubovaginal slings in patients with stress urinary incontinence. J Urol 159:1195CrossRefPubMedGoogle Scholar
  12. 12.
    Rackley RR, Abdelmalak JB, Tchetgen MB, Madjar S, Jones S, Noble N (2001) Tension-free vaginal tape and percutaneous vaginal tape procedures. Tech Urol 7:90–100PubMedGoogle Scholar
  13. 13.
    Nitti VW, Carlson KV, Blaivas JG, Dmochowski RR (2002) Early results of pubovaginal sling lysis by midline sling incision. Urology 59(1):47–51CrossRefPubMedGoogle Scholar
  14. 14.
    Cross CA, Cespedes RD, English SF, McGuire EJ (1998) Transvaginal urethrolysis for urethral obstruction after anti-incontinence surgery. J Urol 159(4):1199–1201CrossRefPubMedGoogle Scholar
  15. 15.
    Petrou SP, Brown JA, Blaivas JG (1999) Suprameatal transvaginal urethrolysis. J Urol 161(4):1268–1271CrossRefPubMedGoogle Scholar
  16. 16.
    Zimmern PE, Hadley HR, Leach GE, Raz S (1987) Female urethral obstruction after Marshall–Marchett–Krantz operation. J Urol 138:517PubMedGoogle Scholar
  17. 17.
    Webster GD, Kreder KJ (1990) Voiding dysfunction following cystourethropexy: its evaluation and management. J Urol 144:670PubMedGoogle Scholar
  18. 18.
    Carr LK, Webster GD (1997) Voiding dysfunction following incontinence surgery: diagnosis and treatment with retropubic or vaginal urethrolysis. J Urol 157:821CrossRefPubMedGoogle Scholar
  19. 19.
    Blaivas JG, Groutz A (2000) Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn 19:553–564CrossRefPubMedGoogle Scholar
  20. 20.
    Nitti VW, Tu LM, Gitlin J (1999) Diagnosing bladder outlet obstruction in women. J Urol 161(5):1535–4150, MayCrossRefPubMedGoogle Scholar
  21. 21.
    Nitti VW, Raz S (1994) Obstruction following anti-incontinence procedures: diagnosis and treatment with transvaginal urethrolysis. J Urol 152(1):93–98PubMedGoogle Scholar
  22. 22.
    Foster HE, McGuire EJ (1993) Management of urethral obstruction with transvaginal urethrolysis. J Urol 150:1448–1451PubMedGoogle Scholar
  23. 23.
    Goldman HB, Rackley RR, Appell RA (1999) The efficacy of urethrolysis without resuspension for iatrogenic urethral obstruction. J Urol 161:196–199CrossRefPubMedGoogle Scholar

Copyright information

© International Urogynecology Journal 2005

Authors and Affiliations

  • Jennifer T. Anger
    • 1
  • Cindy L. Amundsen
    • 1
    • 2
  • George D. Webster
    • 1
    Email author
  1. 1.Division of Urology, Department of SurgeryDuke University Medical CenterDurhamUSA
  2. 2.Division of Urogynecology, Department of Obstetrics and GynecologyDuke University Medical CenterDurhamUSA

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