Laparoscopic Burch Bladder Neck Suspension in Treatment of Female Stress Urinary Incontinence
Tarek Osman EI-Sayed Osman;
Abstract
The aim of this study was to thoroughly evaluate laparoscopic bladder neck suspension in treatment of stress urinary incontinence.
The disease, SUI, is of considerable controversy and laparoscopy is a relatively new minimally invasive approach in treatment of SUI. Bearing in mind these two important factors we tried to be objective and non-biased to a great extent in our work. We followed strict inclusion criteria, and we assessed the procedure by following stringent subjective; semi-objective and objective evaluation methods. We interpreted our results with great caution and analyses of the data followed scientific and statistical basis as much as possible.
A preliminary animal training program was carried out prior to the
clinical study to master most of the laparoscopic skills required for this work since laparoscopy was a relatively new practice in our department.
Comprehensive evaluation of all the patients presenting at our outpatient clinic . with SUIwas carried out to select those most appropriate for our study.
Generally, we included only patients with anatomical (or mainly
anatomical) SUI; i.e. patients with hypermobile vesica-urethral unit and a VLPP of 60cmH20. We also included some patients presenting with a mixed form of incontinence (stress and urge incontinence) provided that urge incontinence is not the original presentation and there was no evidence of motor detrusor instability on cystometric testing. The total number included in the study was 50 patients.
We performed LBNS (utilizing the Burch technique) through the
transperitoneal approach in 22 patients and through the extraperitoneal approach in 26 patients while in 2 patients LBNS was transformed into open surgery.
Detailed evaluation of the procedures was performed. Our subjective evaluation included symptom assessment, evaluation of the number and degree of pad wetness and quality of life scoring. Our objective evaluation included tl'lorough pelvic examinations, radiologic studies, cystoscopic examinations and urodynamic testing. These follow-up criteria were augmented with subjective and objective SEAPIscoring in order to quantify data for better assessment of the outcome.
Our follow-up comprised three main stages of evaluation: early follow
up (less than 6 months after surgery, the average was 4.6 months),late
_ •-- . follow-up (more than 1.5 years, the average was 18.9 months) arid long
term follow-up (more than 2 years after surgery, the average was 26.5 months).
Results Overview
LBNS achieved a satisfactory success rate as well as a highly significant improvement in most of the subjective and objective criteria. Total dryness of 90% was achieved on early evaluation (4-6months).
The disease, SUI, is of considerable controversy and laparoscopy is a relatively new minimally invasive approach in treatment of SUI. Bearing in mind these two important factors we tried to be objective and non-biased to a great extent in our work. We followed strict inclusion criteria, and we assessed the procedure by following stringent subjective; semi-objective and objective evaluation methods. We interpreted our results with great caution and analyses of the data followed scientific and statistical basis as much as possible.
A preliminary animal training program was carried out prior to the
clinical study to master most of the laparoscopic skills required for this work since laparoscopy was a relatively new practice in our department.
Comprehensive evaluation of all the patients presenting at our outpatient clinic . with SUIwas carried out to select those most appropriate for our study.
Generally, we included only patients with anatomical (or mainly
anatomical) SUI; i.e. patients with hypermobile vesica-urethral unit and a VLPP of 60cmH20. We also included some patients presenting with a mixed form of incontinence (stress and urge incontinence) provided that urge incontinence is not the original presentation and there was no evidence of motor detrusor instability on cystometric testing. The total number included in the study was 50 patients.
We performed LBNS (utilizing the Burch technique) through the
transperitoneal approach in 22 patients and through the extraperitoneal approach in 26 patients while in 2 patients LBNS was transformed into open surgery.
Detailed evaluation of the procedures was performed. Our subjective evaluation included symptom assessment, evaluation of the number and degree of pad wetness and quality of life scoring. Our objective evaluation included tl'lorough pelvic examinations, radiologic studies, cystoscopic examinations and urodynamic testing. These follow-up criteria were augmented with subjective and objective SEAPIscoring in order to quantify data for better assessment of the outcome.
Our follow-up comprised three main stages of evaluation: early follow
up (less than 6 months after surgery, the average was 4.6 months),late
_ •-- . follow-up (more than 1.5 years, the average was 18.9 months) arid long
term follow-up (more than 2 years after surgery, the average was 26.5 months).
Results Overview
LBNS achieved a satisfactory success rate as well as a highly significant improvement in most of the subjective and objective criteria. Total dryness of 90% was achieved on early evaluation (4-6months).
Other data
| Title | Laparoscopic Burch Bladder Neck Suspension in Treatment of Female Stress Urinary Incontinence | Other Titles | عملية بيرش بواسطة منظار البطن لعلاج السلس البولى الإجهادى فى الإناث | Authors | Tarek Osman EI-Sayed Osman | Issue Date | 2000 |
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