Bladder neck suspention - Forum

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सर्जन

Bladder neck suspention - Ärzteforum

Post#1 »

Bladder neck suspention as one of the methods of surgical procedure is becomming very popular among my female patients, suffring from urinary incontinence. How often this procedure practised by you and what is the succes rate among the menopausal women.


Arizona

Re: Bladder neck suspention - Ärzteforum

Post#2 »

I do a lot of these, mostly in conjunction with hysterectomies, but I have also done a lot of them after failed previous surgical procedures (by other surgeons). I think it is essential for any surgeon (including any general surgeon) who does hysterectomies to be able to do an adequate durable procedure for urinary stress incontinence. For those US surgeons (or mobile Chilean or Canadian surgeons who fly to the US frequently), the best course on urinary stress incontinence and appropriate surgery is put on yearly by Northwestern U in Chicago.

I do Burch bladder suspensions (a retropubic urethral sling operation where the vagina is used as the sling). This operation has about an 86% immediate success rate (which is better than the about 75% success rate for the anterior vaginal repairs). It has almost replaced the Marshall-marchetti-Krantz operation because of reports of osteitis pubis and because there is probably more early (first weeks to months) voiding dysfunction (urinary retention) with the Marshall-Marchetti-Krantz operation.

The long term success rate of the Burch procedure is, though, less than the immediate success because the vagina which is used as the sling tends to stretch with time. It is also important for these women to be on and stay on estrogen unless there are contraindications.

The other extremely important technical point is that the apex of the vagina must be well-supported posteriorly (by routine culdeplasty type suspension to the uterosacral ligaments, or by mesh suspension to the sacrum (similar to sacral rectopexy for prolapse but for vaginal suspension, you attach the mesh a few centimeters down the anterior and posterior vagina then use the mesh to bridge the gap to the sacrum--this should be covered with peritoneum, or as a suspension to the sacrospinous ligament). This is important because the normal vaginal angle is directed posteriorly and the Burch bladder suspension brings the vagina anteriorly. This encourages enteroceles or vaginal vault prolapses.

Biliary surgeon

Re: Bladder neck suspention - Ärzteforum

Post#3 »

I also do a large number of Burch bladder neck suspensions. However, I have been doing them exclusively laparoscopically for about the last 4 years. It has a very high success rate (short term, so far) and a very high patient satisfaction rate. The operation takes about 15 minutes, no indwelling catheters are used post-op, the vast majority of patients leave the hospital the next morning and few of those require pain medication stronger that NSAIDS. The work is all done in the preperitoneal space, so any surgeon with experience in lap inguinal hernias would find this to be an easy technique to learn. The major pitfall is understanding the mechanism of the patient's incontinence. The operation works well for stress incontinence, but a large number of older women have mixed incontinence, i.e. urgency incontinence plus stress incontinence. A bladder neck suspension usually won't help urgency incontinence.

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