The routine use of cystoscopy with the Burch procedure

OBJECTIVE: We sought to determine the incidence of unsuspected injury to th e lower urinary tract as detected by intraoperative cystoscopy when the Bur ch procedure is performed. STUDY DESIGN: We reviewed the records of 181 women who underwent pelvic sur gery, which included a Burch retropubic urethropexy for genuine stress urin ary incontinence, between Jan 1, 1998, and Dec 31, 1999. Ali patients under went intraoperative cystoscopy at the completion of the Burch procedure aft er the administration of Intravenous indigo carmine dye. RESULTS: There were 6 (3.3%) injuries to the lower urinary tract. Five of t he injuries were cystotomies that had been recognized during operation. One obstructed left ureter was detected by cystoscopy and relieved by the rele ase of left paravaginal repair sutures. No unsuspected injuries that were d etected by cystoscopy were attributable to the Burch procedure, CONCLUSIONS: The lower urinary tract injury rate was 3.3%. All but one inju ry was recognized before cystoscopy. The one injury was attributed to conco mitant paravaginal repair and not to the Burch procedure.