The suprapubic approach to primary stress urinary incontinence

The Burch procedure: a comprehensive review

The purpose of this review is to provide the obstetrician/gynecologist with a comprehensive review of the open Burch procedure including operative technique and modifications, complications, and success rates. A computerized search of English-language articles was performed on the MEDLINE database. Additional sources were identified through cross-referencing. All identified articles were reviewed with particular attention to operative technique, complication, and success rates. Each reference was reviewed; operative technique and modifications are cited, and all complications are reported here. Overall success rates by length of follow-up are tabulated. Several comparative studies are cited. The Burch procedure via laparotomy has undergone minimal modification since its initial description in 1961. Complications including voiding dysfunction, detrusor instability, and urinary tract infection occur in up to 41 percent of patients, but more serious sequelae such as urinary tract injury, hemorrhage, or venous thromboembolism are rare. Long-term success rates of the Burch procedure range from 61 to 100 percent, which are as good or better than any other incontinence procedure.

Detrusor instability following colposuspension for urinary stress incontinence

Sixty-two patients with genuine stress incontinence (group A) and 30 women with combined detrusor instability and genuine stress incontinence (group B) had a colposuspension operation. The proportion with symptoms of detrusor instability was significantly reduced from 24% before operation to 9% after operation in group A and from 73% to 33% in group B. Urodynamically, detrusor instability developed after surgery in 17 of the 62 patients (27%) in group A whereas only 12 of the 30 women (40%) in group B had detrusor instability after surgery. No urodynamic explanation was found to explain the effect of colposuspension in relieving the symptoms of detrusor instability in some and causing them in others. Nevertheless, it is suggested that colposuspension is helpful for most patients with combined detrusor instability and genuine stress incontinence.

Urodynamic findings following surgery in women with urinary stress incontinence. III. Communication: A modified Marshall-Marchetti-Krantz procedure

Urodynamic data from patients with stress incontinence were assessed before, and one year after, a modified Marshall-Marchetti-Krantz (MMK) procedure. A comparison was made between patients cured and those not cured by the operation. After the operation the maximal urethral closure pressure was significantly raised in both groups (P = 0.0418). The functional urethral length showed only an insignificant increase. Prior to surgery both functional urethral length and maximal urethral closure pressure were significantly higher in those patients who were cured by the operation compared with those who suffered from recurrent incontinence (P =0.00116 and P = 0.00090, respectively). These high preoperative values of urethral closure pressure and functional urethral length seem to be important prognostic factors. A comparison with previously published data from patients operated on by anterior colporrhaphy or the Pereyra suspension showed that urethral closure pressure was highest after the MMK procedure. Therefore the MMK operation seems to be specially suitable for incontinent patients with low maximal urethral closure pressure.

A comparison of vaginal and suprapubic surgery in the correction of incontience due to urethral sphincter incompetence

A preliminary comparison is presented, with pre-operative and post-operative objective assessment, of 25 women undergoing anterior repair and 25 women undergoing colposuspension for the correction of incontinence due to urethral sphincter incompetence. Colposuspension was found to be effective. The mechanism of successful cure was likely to be a combination of bladder neck and proximal urethral elevation and narrowing.

Detrusor instability following surgery for genuine stress incontinence

Nnety-two female patients with genuine stress incontinence, and with otherwise normal bladder function, were treated by a colposuspension operation. Pre-operative and post-operative clinical and urodynamic assessments were performed on all patients. Following surgery 17 of them were found to have detrusor instability.

Modification of Marshall-Marchetti-Krantz operation

In a classic article published in 1949 Marshall, Marchetti, and Krantz demonstrated that stress incontinence in women without uterine prolapse could be corrected by a simple vesicourethral suspension. Beginning in 1960 one of the authors (W.E.C.) became concerned about suturing the urethra to the periosteum of the pubis. It occurred to him that use of the upper sutures only to pull up the bladder and hold its anterior wall to the back of the rectus muscles might be just as effective, and this has proved to be so.

Recurrent stress urinary incontinence in the female

1,500 females presenting with recurrent urinary incontinence were investigated in depth. 27% required further surgery, 127 of whom were treated with a 2-team Marlex sling. Careful assessment is the key to treatment including cystoscopy and good radiological documentation. One must be aware of the capabilities and limitations of the various procedures employed for stress incontinence and select the correct procedure for the given problem. When dealing with recurrent stress incontinence the surgical procedure must take down all periurethral scar, anteriorly and posteriorly and adequately elevate the urethrovesical junction so it is not the dependent point at the base of the funnel. The Marlex sling procedure fulfills the above criteria, has been singularly effective, and remarkably free of complications.