URINARY COMPLAINTS AFTER MODIFIED BURCH URETHROPEXY - AN ANALYSIS

OBJECTIVE: Postoperative bladder complaints after incontinence procedu res are well known to the pelvic surgeon, but there are few reports co mparing subjective complaints with objective data. Thirty of 68 patien ts who underwent a modified Burch urethral suspension were interviewed and examined by the first author. Four-channel urodynamics were then performed. STUDY DESIGN: Of the 30 patients, eight (27%) complained of postoperative urinary leaking, and three of eight (10%) said they lea ked worse than before surgery. Four patients (13%) had objective evide nce of detrusor instability on cystometrogram. Two patients (6%) had r ecurrent genuine stress incontinence. No patients had bladder spams or symptoms of retention. Univariate and multivariate analyses were perf ormed on the following preoperative patient factors in relation to sur gical success: age, height, hormonal status, and concurrent pelvic rel axation. Only preoperative hormone use had statistical significance in relation to surgical success. RESULTS: The eight patients with leakin g were treated on the basis of subjective complaints plus objective fi ndings. The patients with detrusor instability had improvement with me dication and bladder drills, but two of the four still had mild leakag e. Of the other four patients, one required a urethral sling and is no w dry. The other three patients had significant improvement or cure of symptoms after modifications were made in their voiding techniques. C ONCLUSION: Our study suggests that preoperative and postoperative estr ogen use is significantly correlated with surgical success of the Burc h procedure, whereas age, weight, and postoperative pelvic relaxation have little influence. We also found that surgical success could be im proved by close evaluation and individual management of patients with voiding complaints.