Friday, October 27, 2006

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Burch colposuspension

Burch colposuspension

There are various surgical options for women with stress urinary incontinence who have not responded to physiotherapy or medications. A Burch colposuspension is an operation, which has been used for many years with good success rates.

This operation can be performed in combination with other procedures.

The advantages to this operation are:

  • It has a good success rate of 80-85% of women becoming cured or significantly improved with their incontinence.
  • Research has shown that the success rate continues for many years.
  • It may be performed as "keyhole" (laparoscopic) surgery. This depends on a number of factors and your doctor will discuss this with you.
  • It may be used to add support to the front wall of the vagina.

What happens during surgery?

  • The operation requires you to have a full (general) anaesthetic.
  • The incision may be a lower transverse incision below the pubic hairline or 3 small incisions, if keyhole surgery is used.
  • Permanent stitches are then placed near the neck of the bladder and fixed to the back of the pubic bone (the bone at the lower part of the abdomen).
  • The wounds are then closed.
  • At the end of the operation the surgeon looks inside your bladder with a medical telescope to check for bladder injury.
  • The operation takes 45-60 minutes to perform.

Burch colposuspension diagram 1

Burch colposuspension diagram 2

How do I know if this operation is for me?

A special investigation will be done to confirm the diagnosis and that there is no other cause for your incontinence.

Urodynamic testing is done to check how well the bladder is working. This test will also help your surgeon make an informed decision with you about the suitability of this operation.

Can there be any complications?

There can be complications with any type of surgery but serious complications are rare. The risks are:

  • Between one and ten in a hundred women will have trouble going to the toilet and may need a catheter after the surgery until normal bladder emptying is established. Less than one in a hundred women will have long term problems needing a catheter for a long period.
  • About ten in a hundred women will develop an irritable bladder.
  • One to five women in a hundred will develop a urinary infection.
  • One in a hundred women will develop a wound infection.
  • Less than one in a hundred women need a blood transfusion
  • One in a hundred women will have damage to the bladder or urinary tract and this is usually repaired at the same time as the operation.
  • A small chance of damage to blood vessels, ureters or bowels during the operation.
  • Occasionally keyhole surgery may need to be changed to a larger incision during the surgery due to complications.

Recovery time

Most women stay in hospital for 3-4 days. You will be sent home once you are feeling well and once you are able to pass urine with no problem.

It is important to rest after the operation and allow the area to heal. Generally it is recommended:

  • You restrict activity for two weeks.
  • After 2 weeks do light activity only.
  • Avoid heavy lifting for 6 weeks, including shopping bags, washing baskets and children.
  • Abstain from sexual activity for 6 weeks.
  • Avoid playing sport for 6 weeks.

For further reading
at Emedicine
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Tags :urinary incontinence, stress incontinence, SUI, enuresis, urinary leakage, urogynecology, bladder, urethra, ureters, pelvic floor, weakening of connective tissue, genitourinary atrophy due to hypoestrogenism, nocturnal diuresis, involuntary bladder contractions, detrusor hyperreflexia, vesicovaginal fistula, vesicocutaneous fistula, exstrophy of the bladder, genuine stress incontinence, GSI, urethral diverticula, epispadias, intrinsic sphincter deficiency, ISD, urethral instability, overflow incontinence, outlet obstruction, detrusor instability, DI, urge incontinence, continuous incontinence, functional incontinence, benign prostatic hyperplasia, BPH, mixed incontinence, Marshall-Bonney test, modified Marshall-Marchetti-Krantz procedure, Ball-Burch procedure, paravaginal repair, laparoscopic retropubic urethropexy, needle urethropexy, suburethral sling procedure, tension-free vaginal tape, patch sling with suture arms, paraurethralfascial sling urethropexy, microwave therapy, periurethral injection procedure, fistula repair, urethral diverticulum repair, cystoplasty, denervation procedure, implantable sacral neuromodulation device, artificial urethral sphincter, urinary diversion, complex reconstructive procedure, Kegel exercises
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