Randomized comparison of Burch urethropexy procedures concomitant with gynecologic operations.
ABSTRACT We compared the success of laparoscopic Burch colposuspension with the laparotomic Burch colposuspension for the treatment of genuine stress incontinence (GSI) concomitant with gynecologic operations.
Fifty-two women with symptoms of GSI, also requiring additional gynecologic operations, were randomly assigned to undergo laparoscopic (n = 26) or laparotomic (n = 26) Burch colposuspension. For all patients complete histories were taken and physical examination, urinalysis, urine culture, multi-channel urodynamics with cystometry, uroflowmetry, and measurement of Valsalva leak-point pressure were performed. Variables analyzed included: age, surgical time, length of catheterization, number of days in hospital, and complications.
Both groups were similar in age, parity and menopausal status. Valsalva leak-point pressure significantly increased in the laparoscopy group after the operation. There were no statistical differences in other urodynamics in both groups. The mean operating time in the laparoscopy group was longer than in the laparotomy group. The laparoscopy group required a significantly shorter hospitalization and catheterization than the laparotomy group. The success and complication rates did not differ significantly for both groups.
The laparoscopic approach for the treatment of GSI in patients requiring additional gynecologic procedures is associated with a shorter duration of hospital stay compared with the abdominal approach.
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ABSTRACT: Urinary incontinence is a common and potentially debilitating problem. Open retropubic colposuspension is a surgical treatment which involves lifting the tissues near the bladder neck and proximal urethra in the area behind the anterior pubic bones to correct deficient urethral closure. To assess the effects of open retropubic colposuspension for the treatment of urinary incontinence. We searched the Cochrane Incontinence Group Specialised Register (searched 13 March 2012), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and CINAHL, and handsearching of journals and conference proceedings, and the reference lists of relevant articles. We contacted investigators to locate extra studies. Randomised or quasi-randomised controlled trials in women with symptoms or urodynamic diagnoses of stress or mixed urinary incontinence that included open retropubic colposuspension surgery in at least one trial group. Studies were evaluated for methodological quality or susceptibility to bias and appropriateness for inclusion and data extracted by two of the review authors. Trial data were analysed by intervention. Where appropriate, a summary statistic was calculated. This review included 53 trials involving a total of 5244 women.Overall cure rates were 68.9% to 88.0% for open retropubic colposuspension. Two small studies suggested lower incontinence rates after open retropubic colposuspension compared with conservative treatment. Similarly, one trial suggested lower incontinence rates after open retropubic colposuspension compared to anticholinergic treatment. Evidence from six trials showed a lower incontinence rate after open retropubic colposuspension than after anterior colporrhaphy. Such benefit was maintained over time (risk ratio (RR) for incontinence 0.51; 95% CI 0.34 to 0.76 before the first year, RR 0.43; 95% CI 0.32 to 0.57 at one to five years, RR 0.49; 95% CI 0.32 to 0.75 in periods beyond five years).Evidence from 20 trials in comparison with suburethral slings (trans-vaginal tape or transobturator tape) found no significant difference in incontinence rates in all time periods assessed.In comparison with needle suspension, there was a lower incontinence rate after colposuspension in the first year after surgery (RR 0.66; 95% CI 0.42 to 1.03), after the first year (RR 0.48; 95% CI 0.33 to 0.71), and beyond five years (RR 0.32; 95% CI 15 to 0.71).Patient-reported incontinence rates at short, medium and long-term follow-up showed no significant differences between open and laparoscopic retropubic colposuspension, but with wide confidence intervals. In two trials incontinence was less common after the Burch (RR 0.38; 95% CI 0.18 to 0.76) than after the Marshall Marchetti Krantz procedure at one to five year follow-up. There were few data at any other follow-up times.In general, the evidence available does not show a higher morbidity or complication rate with open retropubic colposuspension compared to the other open surgical techniques, although pelvic organ prolapse is more common than after anterior colporrhaphy and sling procedures. Open retropubic colposuspension is an effective treatment modality for stress urinary incontinence especially in the long term. Within the first year of treatment, the overall continence rate is approximately 85% to 90%. After five years, approximately 70% of patients can expect to be dry. Newer minimal access procedures such as tension-free vaginal tape look promising in comparison with open colposuspension but their long-term performance is not known and closer monitoring of their adverse event profile must be carried out. Laparoscopic colposuspension should allow speedier recovery but its relative safety and long-term effectiveness is not known yet.Cochrane database of systematic reviews (Online) 01/2012; 6(6):CD002912. DOI:10.1002/14651858.CD002912.pub5 · 5.94 Impact Factor
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ABSTRACT: This study aim was to compare the efficacy of transobturator tape (TOT) as a new sling procedure, and Burch colposuspension as the gold standard surgical technique, in the treatment of stress urinary incontinence (SUI). This prospective randomised clinical trial was conducted on 62 women with SUI diagnosed with urodynamic test in Vali-e-Asr Hospital, Tehran, Iran. Patients were allocated into two surgery groups, randomly; TOT and Burch (31 patients in each group). After treatment, they were followed-up for long-term outcome. The average duration of follow-up was 22 and 28 months in the TOT and Burch group, respectively. Operation duration and hospital stay in the TOT group was significantly less than the Burch group (p=0.001). The rate of complete cure, improvement and failure in the TOT group was 90.3%, 9.7% and 0%, respectively, as well as 74.2%, 19.4% and 6.5% in the Burch group. In the TOT group, 90.3% of patients were very satisfied, 6.5% moderately satisfied and 3.2% were less satisfied; none of them were unsatisfied. It is concluded that the TOT procedure is a safe and effective option with less operation time and shorter in-hospital stay for SUI treatment.Journal of Obstetrics and Gynaecology 08/2011; 31(6):518-20. DOI:10.3109/01443615.2011.578776 · 0.60 Impact Factor
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ABSTRACT: The kinetic mechanisms of the reactions catalyzed by the two catalytic domains of aspartokinase-homoserine dehydrogenase I from Escherichia coli have been determined. Initial velocity, product inhibition, and dead-end inhibition studies of homoserine dehydrogenase are consistent with an ordered addition of NADPH and aspartate beta-semialdehyde followed by an ordered release of homoserine and NADP+. Aspartokinase I catalyzes the phosphorylation of a number of L-aspartic acid analogues and, moreover, can utilize MgdATP as a phosphoryl donor. Because of this broad substrate specificity, alternative substrate diagnostics was used to probe the kinetic mechanism of this enzyme. The kinetic patterns showed two sets of intersecting lines that are indicative of a random mechanism. Incorporation of these results with the data obtained from initial velocity, product inhibition, and dead-end inhibition studies at pH 8.0 are consistent with a random addition of L-aspartic acid and MgATP and an ordered release of MgADP and beta-aspartyl phosphate.Archives of Biochemistry and Biophysics 12/1990; 283(1):96-101. DOI:10.1016/0003-9861(90)90617-8 · 3.04 Impact Factor