Colposuspension for the Treatment of Female Urinary Incontinence

EDITORIAL COMMENT: This paper reviews the results of a large series of patients with urinary incontinence treated by the Burch colposuspension with a few minor alterations. The operation is performed entirely from above, the vagina being suspended on either side of the bladder neck and attached to the iliopectineal ligament at the pelvic brim. It is noteworthy that only 36 of the 174 patients had pure stress incontinence as a symptom and 59 were obese. Selection of the patient who requires surgery when stress incontinence is associated with urgency and other urinary symptoms is very difficult. All of the 30 patients who remained incontinent after the operaton had urodynamic investigaton and 16 were found to have detrusor instability. It would seem that the author's results justify their willingness to operate on patients with mixed urinary symptoms. The success rate and incidence of complications in this series is consistent with other studies — however, there was a high incidence of voiding difficulties postoperatively as revealed by a mean postoperative catheter drainage time of 10 days, 5 patients requiring to go home using self-catheterization with 2 needing this long-term, and a postoperative incidence of detrusor instability of 10%. One reviewer believes this is due to overelevation of the bladder neck at the time of colposuspension which may be avoided by leaving the suspending sutures long at the time of surgery. The takeaway message is that patients with mixed urinary symptoms who have stress incontinence confirmed urodynamically have a good chance of being cured by surgery. It would be prudent that such patients should have a trial of medical management and pelvic floor exercises before resorting to surgery. Summary: Between June 1, 1983 and June 30, 1988, 174 patients with stress incontinence were treated with a colposuspension operation; 144 patients were cured, 30 remained wet. Sixteen patients who remained wet had detrusor instability; 9 of these were cured by anticholinergic medications. Of 25 patients who had dual pathology 19 were cured. Seventy nine patients had urinary tract infections. Two patients had ureteric obstruction due to kinking; it is postulated that this can be an in-fequent and sometimes unavoidable complication.