Abstract
The aim of the study was to determine the long-term results of Burch procedures combined with vault prolapse repair by abdominal sacrocolpopexy. Between 1986 and 1997 82 women (mean age 46.0 years, range 27–79) underwent sacrocolpopexy combined with a Burch procedure. All patients presented with urinary incontinence and vault prolapse. The surgery consisted of a Burch procedure using non-absorbable suture material, and abdominal sacrocolpopexy with a non-absorbable mesh. The mesh was placed anteriorly and posteriorly in 66 cases, posteriorly (rectovaginal) in 12, and anteriorly (vesicovaginal) in 4. Additional procedures included hysterectomy (34 cases), enterocele repair (79 cases), and posterior repair with perineorrhaphy (65 cases). Failure was defined as the presence of persistent or worsened postoperative stress urinary incontinence (SUI). At a mean follow-up of 86 months (range 24–133) 34% (28/82) of patients were dry, and another 46% (38/82) were improved compared to their preoperative status. The postoperative SUI rate (persistent, worsened) after the placement of a single anterior mesh (4 failures out of 4) was higher than the postoperative SUI rate after combined meshes (41 failures out of 66) (log rank P = 0.05). All the patients with a history of prior surgery had worsened or persistent stress urinary incontinence (7/7), but 63% (47/75) of those with no prior surgery for stress urinary incontinence had worsened or persistent stress urinary incontinence (log rank P = 0.01). One case of recurrent rectocele was observed (after 20 months) and treated by transvaginal Richter sacrospinous fixation. At a mean follow up of 7 years, the Burch procedure combined with abdominal sacrocolpopexy appears to be less effective than previously published long-term results for the Burch procedure alone.
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Abbreviations
- SUI:
-
stress urinary incontinence
References
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Editorial Comment: The authors are to be commended on a well-written and informative report. Its strengths include the fact that all operations were performed by only three surgeons, apparently in a standardized fashion, and that all patients were reassessed during the preparation of this report by physical examination and a structured interview administered by an individual other than one of the three operators. The authors' admonition to avoid excessive tension on suspensory materials used in performing abdominal sacral colpopexy, especially anterior placed suspensory material, is important. The suspensory materials should lie loosely over the anterior surface of the sacrum. It would be interesting to know if barrier testing by reduction of vault prolapse was performed during preoperative urodynamic studies, and if the authors would be willing to proceed directly to suburethral sling if such testing unmasked intrinsic sphincter deficits. One is again reminded by this report that the complete resolution of urinary incontinence in patients with severe prolapse undergoing repeat surgery is frequently not achieved.
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Cosson, M., Boukerrou, M., Narducci, F. et al. Long-term results of the Burch procedure combined with abdominal sacrocolpopexy for treatment of vault prolapse. Int Urogynecol J 14, 104–107 (2003). https://doi.org/10.1007/s00192-002-1028-x
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DOI: https://doi.org/10.1007/s00192-002-1028-x