As the patient was undergoing an abdominal hysterectomy, it was reasonable to perform a retropubic urethropexy
at the same time.
Overall, urodynamic testing was not helpful in the evaluation of women who had POE However, asymptomatic women who leaked during preoperative evaluation were more likely to experience incontinence postoperatively, even if they underwent Burch urethropexy
He showed an example of a Burch suture that was left in the bladder during urethropexy
. Had the suture been identified perioperatively, it could have been easily removed, but because it was identified at a later time, operative cystoscopy was required for removal of the stitch, he explained.
Potentially, these patients could be treated with bulking agents, abdominal or laparoscopic urethropexy
, artificial urethral sphincter, and repeat mid-urethral sling.[sup.6,7]
The colpopexy and urinary reduction efforts (CARE) trial concluded that postoperative stress incontinence in continent women is significantly reduced when sacrocolpopexy is combined with Burch urethropexy
(FIGURE, page 16).
Although the model was better than random chance in predicting the probability of SUI after abdominal sacral colpopexy and Burch urethropexy
in the CARE population, the accuracy was lower, perhaps "because women in the OPUS data set underwent sling with vaginal surgery for prolapse, while those in CARE underwent a Burch procedure and abdominal surgery" he said.
Unlike transabdominal or transvaginal urethropexy
, a sling not only provides support to the vesicourethral junction, but also may create some aspect of urethral coaptation or compression.
Although retropubic urethropexy
has been widely used and is very effective, the newer midurethral, tension free sling procedures are very popular, effective and easier to perform.
(6) Postoperative stress incontinence decreased from 44.1% to 23.8% with the inclusion of a retropubic urethropexy
. This finding was noted at a planned interim analysis, and the difference was so great that it led to early discontinuation of the trial.
In a classic study, researchers used a trial with a lever pessary to successfully predict surgical cure of stress incontinence via retropubic urethropexy
. In this trial, 24 of 26 women with stress UI became continent with a supine stress test after pessary insertion, and all patients remained continent after a retropubic urethropexy
was performed (Bhatia & Bergman, 1985).
With the introduction and approval of MUS in the mid to late 1990s, MUS operations steadily increased the overall number of SUI procedures performed and largely replaced traditional procedures, such as the Burch urethropexy
, over the next 10 years in North America, where the procedures were tracked.
Rapid response to intravenous corticosteroids in osteitis pubis after Marshall-Marchetti-Krantz urethropexy
. Rheumatology (Oxford) 2000;39:1048-9.