Conventional methods to treat urinary stress incontinence, including the Sling, Burch, and Pereyra modification methods, are limited by several shortcomings due to disrupted nerve and vaginal wall integrity. The nerve...Conventional methods to treat urinary stress incontinence, including the Sling, Burch, and Pereyra modification methods, are limited by several shortcomings due to disrupted nerve and vaginal wall integrity. The nerve-sparing Burch-Sling method represents a surgical advancement through the use of a nerve-sparing sling to treat genuine stress urinary incontinence. The procedure involves retropubic urethropexy using the FDA-approved Burch-Sling device. In this technique, the vagina is elevated bilaterally at the urethrovesical junction to the mid-urethra toward Cooper’s ligament above the base of the bladder. Then, the anterior vaginal wall and fascia are used as an endogenous suburethral sling without dissection. Two hundred twenty cases were included in this study;two hundred patients underwent the outpatient nerve-sparing sling method, and the other twenty underwent the novel abdominal Burch method. There were no major complications. The follow-up duration ranged from 6 months to eight years. All procedures were performed at the U.S. Women’s Institute at a 400-bed hospital in Fountain Valley, CA.展开更多
AIM:To theorize that performing a laparoscopic Burch urethropexy at time of sling removal would significantly decrease subjective symptoms of stress urinary incontinence(SUI)and improve patient satisfaction.METHODS:Wo...AIM:To theorize that performing a laparoscopic Burch urethropexy at time of sling removal would significantly decrease subjective symptoms of stress urinary incontinence(SUI)and improve patient satisfaction.METHODS:Women who underwent a combined sling removal and laparoscopic Burch procedure between2009 and 2014 were matched via age and sling-type in a 1:2 ratio to women who only underwent a sling removal.Those who underwent surgery within 6 mo of data collection were excluded from the study,as were women who underwent multi-stage surgery.Preoperative assessment for both groups included a focused clinical exam with or without functional testing and questionnaires including urogenital distress inventory-6(UDI-6)and incontinence impact questionnaire-7(IIQ-7)per the standard clinical practice.All non-exempt women were sent a questionnaire that included UDI-6 and IIQ-7 in addition to standard followup questions.Research staff contacted participants via email,mail,and telephone using the same questionnaire template and script.Data was analyzed by using x^2 test for categorical data,and Student’s t test and Wilcoxon Rank Sum test for continuous data.The measure of effect was determined by logistic regression analysis.RESULTS:A total of 48 women out of 146 selected patients were successfully recruited with n=22 in the Burch cohort and n=26 in the control cohort.The mean age was 54.7±7.8 years and mean body mass index was 22.0±13.9 kg/m^2.The majority of patients were Caucasian(73.3%),postmenopausal(91.1%),nonsmokers(57.9%),with a history of hysterectomy(81.4%).Six nineteen point six percent of women presented after at least 2 years from placement,which was significantly more common in the Burch cohort.Pain was the most common chief complaint(64.4%)in both groups at the time of initial presentation,and 78.9%of women reported concomitant urinary incontinence.There was no significant difference in pre-operative UDI-6 and IIQ-7scores between the two cohorts.However,the change in UDI-6 score postoperatively was significantly improved in the Burch cohort with an average drop in score of28.41 points compared to a decrease of 4.01 points in the control group(P=0.02,95%CI:3.84 to 44.97).Although not statistically significant,the Burch cohort was 58%more likely to show an overall improvement in their score after surgery and 40%more likely to meet the minimal important difference of 11 points(RR=1.58,95%CI:0.97 to 2.57;RR 1.40,95%CI:0.79 to 2.46).The difference in IIQ scores was nonsignificant.There was no significant difference in blood loss,complications,or postoperative pain or dyspareunia.CONCLUSION:Performing a Burch urethropexy during sling removal does not increase complication rates and results in a significant change in validated symptomrelated quality of life scores.展开更多
文摘Conventional methods to treat urinary stress incontinence, including the Sling, Burch, and Pereyra modification methods, are limited by several shortcomings due to disrupted nerve and vaginal wall integrity. The nerve-sparing Burch-Sling method represents a surgical advancement through the use of a nerve-sparing sling to treat genuine stress urinary incontinence. The procedure involves retropubic urethropexy using the FDA-approved Burch-Sling device. In this technique, the vagina is elevated bilaterally at the urethrovesical junction to the mid-urethra toward Cooper’s ligament above the base of the bladder. Then, the anterior vaginal wall and fascia are used as an endogenous suburethral sling without dissection. Two hundred twenty cases were included in this study;two hundred patients underwent the outpatient nerve-sparing sling method, and the other twenty underwent the novel abdominal Burch method. There were no major complications. The follow-up duration ranged from 6 months to eight years. All procedures were performed at the U.S. Women’s Institute at a 400-bed hospital in Fountain Valley, CA.
文摘AIM:To theorize that performing a laparoscopic Burch urethropexy at time of sling removal would significantly decrease subjective symptoms of stress urinary incontinence(SUI)and improve patient satisfaction.METHODS:Women who underwent a combined sling removal and laparoscopic Burch procedure between2009 and 2014 were matched via age and sling-type in a 1:2 ratio to women who only underwent a sling removal.Those who underwent surgery within 6 mo of data collection were excluded from the study,as were women who underwent multi-stage surgery.Preoperative assessment for both groups included a focused clinical exam with or without functional testing and questionnaires including urogenital distress inventory-6(UDI-6)and incontinence impact questionnaire-7(IIQ-7)per the standard clinical practice.All non-exempt women were sent a questionnaire that included UDI-6 and IIQ-7 in addition to standard followup questions.Research staff contacted participants via email,mail,and telephone using the same questionnaire template and script.Data was analyzed by using x^2 test for categorical data,and Student’s t test and Wilcoxon Rank Sum test for continuous data.The measure of effect was determined by logistic regression analysis.RESULTS:A total of 48 women out of 146 selected patients were successfully recruited with n=22 in the Burch cohort and n=26 in the control cohort.The mean age was 54.7±7.8 years and mean body mass index was 22.0±13.9 kg/m^2.The majority of patients were Caucasian(73.3%),postmenopausal(91.1%),nonsmokers(57.9%),with a history of hysterectomy(81.4%).Six nineteen point six percent of women presented after at least 2 years from placement,which was significantly more common in the Burch cohort.Pain was the most common chief complaint(64.4%)in both groups at the time of initial presentation,and 78.9%of women reported concomitant urinary incontinence.There was no significant difference in pre-operative UDI-6 and IIQ-7scores between the two cohorts.However,the change in UDI-6 score postoperatively was significantly improved in the Burch cohort with an average drop in score of28.41 points compared to a decrease of 4.01 points in the control group(P=0.02,95%CI:3.84 to 44.97).Although not statistically significant,the Burch cohort was 58%more likely to show an overall improvement in their score after surgery and 40%more likely to meet the minimal important difference of 11 points(RR=1.58,95%CI:0.97 to 2.57;RR 1.40,95%CI:0.79 to 2.46).The difference in IIQ scores was nonsignificant.There was no significant difference in blood loss,complications,or postoperative pain or dyspareunia.CONCLUSION:Performing a Burch urethropexy during sling removal does not increase complication rates and results in a significant change in validated symptomrelated quality of life scores.
