MULTICHANNEL URODYNAMIC EVALUATION OF LAPAROSCOPIC BURCH COLPOSUSPENSION FOR GENUINE STRESS-INCONTINENCE

Objective: To evaluate the P-year outcome of laparoscopic Burch colpos uspension in treating genuine stress incontinence, and to evaluate the prevention of subsequent vaginal vault prolapse by prophylactic apica l vault repair. Methods: This is a prospective study of 48 consecutive cases diagnosed with genuine stress incontinence and followed for 2 y ears or longer (range 30 to 41 months) after correction by laparoscopi c Burch colposuspension. All patients had a routine urogynecology eval uation, including preoperative and postoperative multichannel urodynam ics. Follow-up testing was done at 6 weeks and I and 2 years. Results: At 6 weeks, 1 year, and 2 years, the cure rate for genuine stress inc ontinence was 98, 93, and 89%, respectively. There was a significant d ecrease in urethral hypermobility and an increase in urethral pressure transmission ratios. Thirty-nine (81%) patients voided spontaneously in less than 24 hours. There was no clinically significant pelvic orga n prolapse at 2 years. Conclusion: The 2-year cure rate and multichann el urodynamics findings for laparoscopic Burch repair are similar to t hose reported for laparotomy. Early results of prophylactic apical vau lt suspension suggest that the incidence of prolapse observed after ro utine retropubic urethropexies may be reduced. (C) 1998 by The America n College of Obstetricians and Gynecologists.