Laparoscopic urethrolysis for urethral obstruction after Burch colposuspension for stress urinary incontinence: cases reports
IUGA Academy. Sardi J. Jun 30, 2018; 213244; 145 Topic: Stress Incontinence

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Laparoscopic urethrolysis for urethral obstruction after Burch colposuspension for stress urinary incontinence: Cases reports

Sardi, J1; Prieto, J2; Maya, G2

1: Hospital Britanico ; 2: Hospital Britanico

Introduction: Urethral and bladder outlet obstruction (BOO) is a recognized complication after most surgical procedures for stress urinary incontinence. The mechanisms involved are thought to be related to an overcorrection of the urethra (kinking and/or compressing the urethra) or excessive scar formation between the pubis and urethra. The recommended treatment is usually surgical that aims to free up the obstructed urethra (urethrolysis). For retropubic bladder neck suspension (BNS) or Burch surgery, laparoscopic surgery offers a less invasive alternative to classical abdominal approach. We report methods and results of performing lap urethrolysis in patients with urethral obstruction after Burch colposuspension.

Objective: The aim is to report the feasibility of performing the laparoscopic approach in these patients

Methods: Four patients presented with voiding difficulties, urinary irritative symptoms and urinary infections after Burch colposuspension. BOO was diagnosed based on history, presenting symptoms, and urodynamic findings, including the maximum flow rate (Qmax) of ≤12 mL/second and detrusor pressure at maximum flow (PdetQmax) of ≥20 cmH2O and in one case complemented with pelvic floor ultrasound. Patients underwent laparoscopic assisted urethrolysis, which consisted of the usual lap exposure of the abdominal cavity, access to the space of Retzius, removal of Burch sutures (when they were find),or scar tissue and hypermobilization of the urethra. The intraoperative and postoperative complications, recovery time, and outcome of the procedure to successfully address the patient’s symptoms were reviewed.

Results: Postoperatively, the 4 patients had complete resolution of the obstructive and irritative symptoms. All had improvement of the postvoid residual volume with a median of 30 mL (range 0-64 mL). Postoperatively, urodynamic studies were repeated in two patients and Pdet and the Qmax decreased from 44 cmH2O before surgery to 22 cmH2O and from 39 to 21 cmH2O, respectively. Qmax increased from 6 to 24 mL/second and from 3 to 18mL/second, respectively. This two patients reported stress urinary incontinence in the postoperative period, both in treatment with pelvic floor biofeedback. No patients reported intra o postoperative complications. All of them where discharged 24 hours postop. The average surgery time was 63 minutes.

Conclusions: Lap assisted urethrolysis is a feasible and attractive minimally invasive procedure to treat BOO after Burch surgery.


Work supported by industry: no.

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