Postoperative funneling after anti-incontinence surgery--a prognostic indicator?--Part 1: colposuspension

How does funneling of the bladder neck after open colposuspension affect the postoperative cure rate?

In a retrospective study, 310 patients who underwent primary colposuspension for urodynamically proven genuine stress urinary incontinence were assessed by introital ultrasound before and immediately after surgery as well as at 6, 12, 24, 36, and 48 months. A total of 152 women completed 48-month follow-up. Objective cure rates at the different follow-up times were calculated and correlated with the presence of postoperative bladder neck funneling.

The objective cure rate up to 6 months after colposuspension was 90.0 versus 76.8% up to 48-month follow-up. Urge symptoms occurred in 11.6% (36/310) of the women and de novo urge incontinence in 1.6% (5/310). Bladder neck funneling was significantly reduced after anti-incontinence surgery, from 55.2% before surgery to 12.3% (38/310) at 6-month follow-up (P < 0.0001). Postoperative funneling was associated with a higher recurrence rate. In the funneling group, 58.8 and 40.6% of the patients were continent up to 6 and 48 months, respectively, as opposed to 93.8 and 81.3% in the group without funneling (P < 0.0001). Urgency and de novo urge incontinence were more common in the funneling group (23.5 and 28.3% up to 6 and 48 months, respectively, vs. 12.7 and 13.5%; P < 0.05).

Patients in whom funneling of the bladder neck diagnosed before surgery persists after colposuspension have a higher risk of recurrence and are more likely to develop postoperative complications.