Ultrasound imaging of the lower urinary system in women after Burch colposuspension

Objective Most of the relevant surgical procedures employed in the manageme nt of genuine stress urinary incontinence (GSI) involve the technique of bl adder neck elevation. The appropriate level of suspension is an important ( but frequently overlooked) consideration as the clinical consequences of ov er-correction of the posterior angle are voiding dysfunction and urgency sy mptoms. The aim of our study was to compare ultrasound characteristics in w omen with GSI with those of women before and after Burch colposuspension. T he findings of our study should have implications for GSI management. Design Prospective randomized clinical study at the Department of Obstetric s and Eynecology, Charles University, Prague, Czech Republic. Setting Department of Obstetrics and Gynecology, Charles University, Prague , Czech Republic. Methods Seventy women with previously untreated GSI (pre operative group)an d SZ women (42 of whom had been in the preoperative group) who were studied 3-12 months after receiving Burch colposuspension (postoperative group) too k part in the study. The standard transperineal and introital ultrasound sc ans were performed. The mobility of the bladder neck was assessed transperi neally with a curved array probe after instillation of 300 mL of saline. Th e bladder was then evacuated and the thickness of the urinary bladder wall in the sagittal plane in defined regions (base, vertex and anterior wall) w as measured. Results We found significant differences in bladder neck position, mobility , and in bladder wall thickness. Where symptoms of urgency occurred, the av erage bladder wall thickness was > 5 mm, the gamma angle < 40<degrees> and lower bladder neck mobility was evident. Conclusion These findings supported our hypothesis that signs of urgency fo llow over-elevation of the bladder neck. These results helped us significan tly to refine our GSI management.