Irritative symptoms after colposuspension: Are they due to distortion or overelevation of the anterior vaginal wall and trigone?

Symptoms of bladder irritability are common after incontinence surgery but their cause is unknown. This study tests the hypothesis that irritative sym ptoms after colposuspension are due to distortion of the trigone. As part o f longitudinal follow-up studies, 175 women were examined 6 months to 12 ye ars after either an open or a laparoscopic Burch colposuspension. The main outcome measures were symptoms of bladder irritability (frequency, nocturia and urge incontinence) and ultrasound findings (bladder neck position at r est and on Valsalva, the presence of a colposuspension ridge, ridge depth a nd ridge distance, and trigonal angle). Two positive associations between u ltrasound parameters and symptoms of bladder irritability were observed: ur ge incontinence was more likely in the presence of bladder neck funneling, and women with nocturia had a higher trigonal angle. Increased distortion o f the trigone was associated with a reduced incidence of urge incontinence in the subgroup of patients after laparoscopic colposuspension. The data pr esented in this study do not support the hypothesis that symptoms of bladde r irritability are due to trigonal distortion or overelevation.