Laparoscopic bladder neck suspension.

Abstract

The preferred therapy for genuine stress incontinence is surgery. The Burch procedure is considered by many to be the gold standard for surgical treatment of genuine stress incontinence. The Burch procedure requires the elevation of the anterior wall of the vagina to the level of the origin of the paravaginal fascia by suspension from Cooper's ligaments (iliopectineal ligaments). A properly performed Burch procedure cures 93 percent. The laparoscopic performance of the Burch procedure results in a decrease in the length of hospital stay, faster recovery, and less scarring due to the smaller incisions. In a consecutive series of thirty patients the average length of stay in hospital was thirty-six hours and the patients were able to return to non-stressful regular activities within one week of surgery. There were no conversions to the open Burch procedure. Intraoperative and postoperative complications included one electrocautery injury of the bladder requiring laparoscopic suture reinforcement of the bladder and three weeks of bladder drainage, three episodes of transient detrusor instability requiring medical therapy for two months, and two episodes of urinary retention requiring bladder drainage for two weeks. The laparoscopic procedure provides results similar to the open operation if a meticulous technique is used.