Secondary colposuspension: results of a prospective study from a tertiary referral centre

Abstract

Objective To evaluate the results of secondary colposuspension in women with recurrent urinary stress incontinence. Design Prospective cross sectional observational study.Setting Tertiary referral urogynaecology unit.Population Fifty-six women with recurrent stress incontinence.Main outcome measures Determine prognostic factors that may affect the outcome of surgery, long term subjective and objective success rates and identify complications of secondary colposuspension. Results The mean age was 54 years (range 34-83) and the median parity was 3 (range 1 -5). The median length of follow up was four years (range 1.01-7.07). Forty-two (75%) women had genuine stress incontinence and 14 (25%) had mixed incontinence on subtracted cystometry. The subjective cure rate was 71% and the objective cure rate was 80% and, as per Kaplan -Meier life time analysis, 65% had not failed surgery five years after the operation. The complication rate was low. However at follow up, eight women had required a posterior colporrhaphy for rectocele and three had a sacrocolpopexy for vault prolapse. Another eight women required further treatment for stress incontinence (seven urethral bulking agents and one tension-free vaginal tape). There was no correlation of the outcome to age, past hysterectomy, number of previous incontinence procedures, parity, body mass index or blood loss at operation. Conclusion Colposuspension after failed continence surgery has a good outcome with a low complication rate, but many still require further surgery for prolapse.

Laparoscopic Burch colposuspension after failed sub-urethral tape procedures: a retrospective audit

“…However, urodynamic studies performed at time of post-operative review revealed a significant decrease in flow rate, which may reflect an element of outflow obstruction, although urinary residuals were low. These findings are in line with that of other authors [3,5,6,25,26].…”

“…We did not exclude patients with a low-pressure urethra and intrinsic urethral sphincter deficiency, which is thought to be an important factor in failure of continence surgery [22,23]. This could be a possible explanation for our low objective success rate compared with other reports in literature [3,5,6,12]. We measured an MUCP<20 mmH 2 O in 37.5% (n=6 of 16) of the women included in this study.…”

“…Colposuspension after previous failed incontinence surgery has been reported to be a feasible choice to treat patients with recurrent stress urinary incontinence [3][4][5][6], although it is believed more likely to fail with increasing number of previous procedures [7,8]. It has a higher complication rate [3,9] and can be technically difficult, especially after previous retropubic surgery [6].…”

The surgical management of recurrent stress urinary incontinence: a systematic review

“…for Burch colposuspension after various index procedures, with objective cure rates of 81.1% (43/53 patients) . Two other studies on open colposuspension for failed continence procedures report objective and subjective cure rates to be 78–80 and 71–80%, respectively .…”

“…Seven studies on Burch colposuspension for recurrent SUI have reported in a total of 276 cases, with a 76% overall success rate (95% CI ±5.04) . According to Amaye‐Obu et al., who studied 26 patients, the Burch procedure had a cure rate of 81% (95% CI ±15.08) when it was carried out after one previous failed procedure (any procedure), 25% when it was done after two previous surgeries, and 0% after three previous procedures at a 2‐year follow up.…”