A review of results in a series of 113 laparoscopic colposuspensions

The case records of 113 women having laparoscopic retropubic colposuspensions (Burch procedure) performed for the treatment of genuine urinary stress incontinence between December, 1992 and April, 1995 were retrospectively reviewed. The mean age of the group was 49.4 (30-80) years, mean weight 72.1 (44.5-114) kg, and mean parity 2.7 (0-8). All patients had preoperative urodynamic study to confirm genuine stress incontinence (GSI). Sixteen patients (14%) had dual pathology (GSI and detrusor instability). A transperitoneal approach was used in 93 operations and extraperitoneal in 20. The mean operating time was 108 (30-320) minutes and mean hospitalization 3.3 (1-10) days. In 13 women the operation was converted to laparotomy; 10 due to adhesions and diminished bladder mobility, 1 for inferior epigastric vessel injury, 1 for an ovarian tumour discovered incidentally at the procedure and 1 for equipment problems. Operative complications included 10 cystotomies (5 repaired laparoscopically), 2 extraperitoneal cases converted to transperitoneal, 1 inferior epigastric vessel injury, 1 vaginal tear, 1 suture through the bladder and 1 case of possible enterotomy oversewn at laparoscopy. The mean follow-up period was 8.4 (1-28) months. All patients were reviewed postoperatively and then contact was attempted either by telephone or in consultation. There was an overall 87% subjective success rate. Two patients felt sutures tear out at 4 and 6 months and were deemed failures; 4 felt their incontinence was improved but had ongoing stress incontinence of urine; 9 had symptoms of detrusor instability and one developed an enterocele 9 months after surgery.