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Laparoscopic Burch urethropexy in a private clinical practice
E G Jacome1, G Tutera, F T Mattox
1Eisenhower Medical Center, Rancho Mirage, California, USA.
Study Objective:
To determine the effectiveness of laparoscopic Burch urethropexy in a private practice setting.
Design:
Prospective, observational study (Canadian Task Force classification II-2).
Setting:
Private practice.
Patients:
Fifty-one consecutive women with stress urinary incontinence (15 genuine stress urinary incontinence, 36 concomitant degrees of pelvic organ prolapse).
Intervention:
Laparoscopic Burch urethropexy was performed with sutures in 36 patients and with mesh and staples in 15, in combination with laparoscopic vaginal vault suspension, paravaginal repair, laparoscopic-assisted vaginal hysterectomy, and other procedures.
Measurements And Main Results:
Intraoperative complications occurred in 10% of cases; all were recognized and repaired laparoscopically. Operating time ranged from 55 minutes to 3 hours (median 2 hrs 25 min). Forty-four (86%) surgeries were done on an outpatient basis, five women required an overnight stay, and two were admitted. Forty-seven (93%) patients were discharged without a catheter; two had urinary retention requiring a catheter for 5 days. Follow-up ranged from 12 to 42 months (average 24 mo). Forty-eight women (94%) were cured, three (6%) failed therapy, and six (12%) developed de novo detrusor instability.
Conclusion:
Burch urethropexy can be performed safely by laparoscopy in a private practice setting with success similar to that of open technique. Most intraoperative complications can be corrected laparoscopically with no increase in morbidity. (J Am Assoc Gynecol Laparosc 6(1):39-44, 1999)