Randomised comparison of Burch colposuspension versus anterior colporrhaphy in women with stress urinary incontinence and anterior vaginal wall prolapse.
ABSTRACT To compare the Burch colposuspension and the anterior colporrhaphy in women with both stress urinary incontinence and advanced anterior vaginal wall prolapse (cystocele).
Prospective randomised study.
Secondary referral centre, Urogynaecology Unit, San Gerardo Hospital, Monza, Italy.
Seventy-one women undergoing surgery for primary genuine stress incontinence and concurrent grade 2 or 3 cystocele (descending at or outside the vaginal introitus).
Full urodynamic investigation performed pre-operatively and repeated six months after surgery. Clinical follow up continued for 8 to 17 years.
Subjective (patient history) and objective (negative stress test result) cure of stress incontinence. Assessment of cystocele recurrence.
Thirty (86%) of the 35 evaluable women who had the Burch colposuspension and 17 (52%) of the 33 evaluable women who had the anterior colporrhaphy were subjectively cured (OR 5.6, 95% CI 1.6 to 21.6; P = 0.005). Objective cure rates were 74% (26 of 35) and 42% (14 of 33), respectively (OR 3.9, 95% CI 1.3 to 12.5; P = 0.02). A recurrent cystocele of grade 2 or 3 with or without prolapse at other vaginal sites was recorded in 34% (12 of 35) and 3% (1 of 33) of women, respectively (OR 16.7, 95% CI 2.0 to 368.1; P = 0.003).
The Burch colposuspension was better in controlling stress incontinence but it lead to an unacceptable high rate of prolapse recurrence. The anterior colporrhaphy was more effective in restoring vaginal anatomy but it was accompanied by an unacceptable low cure rate of stress incontinence. Neither of the two operations is recommended for women who are suffering from a combination of stress incontinence and advanced cystocele.
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ABSTRACT: Vaginal repair has been recommended in cases of stress urinary incontinence and posterior bladder suspension defect diagnosed by colpocysto-urethrography. Thirty-eight women with stress urinary incontinence and posterior suspension defect have been treated. First, 19 women underwent a vaginal repair. In a second period, another 19 consecutive patients had a colposuspension a.m. Burch. The patients have been evaluated 6 months postoperatively and at a long-term follow-up. No significant difference was found postoperatively in the frequency of symptoms and signs of stress incontinence, either after 6 months or at the long-term follow-up. A significantly smaller frequency of genital prolapse was found in the colposuspension group at long-term follow-up. No side effects such as frequency, urgency or bacteriuria were evident in the group treated by colposuspension. With reservation to the non-randomized allocation, it may be concluded that a radiographic distinction between anterior and posterior bladder suspension defects in choosing the surgical approach is unnecessary.Acta Obstetricia Et Gynecologica Scandinavica 02/1990; 69(1):55-9. · 1.85 Impact Factor
- British Journal of Obstetrics and Gynaecology 02/1990; 97(1):1-3.
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ABSTRACT: Forty-two patients with urinary incontinence and related symptoms were treated by colposuspension. Two patients were lost to follow-up and the results of surgery in the remaining 40 patients are presented and discussed. The place of vaginal surgery in women with urinary symptoms is also discussed.British Journal of Obstetrics and Gynaecology 12/1976; 83(11):890-5.