VOIDING FUNCTION AFTER BURCH COLPOSUSPENSION FOR STRESS-INCONTINENCE

OBJECTIVE: To evaluate changes in voiding function before and after Bu rch colposuspension for genuine stress incontinence. STUDY DESIGN: Ful l urodynamic evaluations were performed before and three months after surgery on 21 patients undergoing Burch colposuspension for genuine st ress incontinence. Sixteen patients underwent the Burch procedure alon e, and five underwent an abdominal sacral colpopexy for vaginal vault prolapse in addition to the Burch procedure. The preoperative and post operative urodynamic studies were compared with each other to see what changes in voiding function had occurred as the result of surgery. RE SULTS: Statistical analysis of the differences between the preoperativ e and postoperative urodynamic studies using blocked analysis of varia nce showed dramatic decreases in both instrumented and noninstrumented peak and mean urine flow rates and an increase in detrusor pressure a t peak urinary flow during voiding. A substantial but not statisticall y significant increase in mean residual urine was found after surgery in patients who underwent the Burch procedure alone. There were no sta tistically significant differences in these parameters in patients und ergoing the Burch procedure combined with abdominal sacral colpopexy. Using the criteria of a flow rate of < 12 mL/sec in association with a voiding detrusor pressure >50 cm H2O, five patients undergoing the Bu rch procedure alone had evidence of postoperative outflow obstruction. Three women with complete vaginal vault prolapse had functional outle t obstruction before surgery, and another three women had postoperativ e out let obstruction following the combined Burch procedure and sacra l colpopexy. CONCLUSIONS: Burch colposuspension produced significant c hanges in postoperative voiding function three months after surgery, a nd outflow obstruction induced by surgery appeared to be a significant potential complication. Renewed attention should be devoted to the de velopment of durable but nonobstructive operations for the surgical cu re of genuine stress incontinence.