LAPAROSCOPIC RETROPUBIC COLPOSUSPENSION FOR THETREATMENT OF GENUINE STRESS INCONTINENCE. LONG TERMFOLLOW-UP

Risultato della ricerca: Other

Abstract

Objectives: The minimal surgical treatment of stress urinaryincontinence with endoscopic operation has four basic advantagescompared with traditional open procedures: decreased blood lossdue to better visualization of the space of Retzius, decreasedpostoperative pain, shorter hospitalization and faster recovery.Comparative studies have shown a higher subjective and objectivecure rate for the retropubic urethropexy(Burch procedure) thanfor the anterior colporraphy or endoscopic needle urethropexy(1).The aim of this study is to evaluate the safety, the efficacy andmorbility of laparoscopic Burch procedure for the surgical treatmentof genuine stress incontinence.Methods: We reviewed the results of 87 patients who underwentL.B. between 1997 and 2003 by the same surgeon. The main agewas 52 years (range 42-71), the mean body weight was 65 Kg.(range50-73) and the mean parity was 3 (range 1-5) . 55 post menopausalpts. (63,5%) were taken a systemic or local estrogen therapy.All pts. preoperativelly underwent a complete urogynaecologicalwork-up (Q tip test, Vaginal profile, Pad test, Urodynamicinvestigation and Urethrocystoscopy). All the pts. showed S.U.I.mainly grade II (according to Ingelman Sundeberg) and urethralhypermobility nearly always associated with cystocele of I-II degreeand uterus-prolapse or vault prolapse of different degree. For thisreason we performed associated laparoscopic procedures like totalhysterectomy on 52 pts(60%), Mc Call culdoplasty on 70 pts(80%), paravaginal repair on 35 pts (40%) and colposacropexy on24 pts.(28%). We perfomed LPS Burch alone on 10 of the patients(9%). A follow-up questionaire on urinary function and quality oflife was obtained.Results: The main operative time for L.B. was 67 minutes(range 40-120), estimated blood loss was minimum and meanhospital stay was 24 hours. The foley catheter was removed after6-12 h. No bladder or uretheral injures occurred. At 5 years followup60 pts (69%) were continent, 5 pts. (5.7%) de novo instability,6 pts (%) were somewhat improved and 17 pts were completefailures.Conclusions: Laparoscopic Burch procedure seems to be afeasible alternative to the open Burch today for a different and lesstraumatic approach, for a lower morbility and for a shorter hospitalstay
Lingua originaleEnglish
Numero di pagine0
Stato di pubblicazionePublished - 2003

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