Diagnosis and management in women with lower urinary tract symptoms (LUTS) after Burch colposuspension

Czech version

Authors: J. Feyereisl; L. Krofta
Authors‘ workplace: Ústav pro péči o matku a dítě, Praha, ředitel doc. MUDr. J. Feyereisl, CSc.
Published in: Ceska Gynekol 2011; 76(6): 425-438
Category: Original Article

Overview

Objective:
To demonstrate the significance of introital ultrasound of the lower urinary tract in the diagnostic algorithm in patients with lower urinary tract symptoms (LUTS) after Burch colposuspension.

Methods:
Twenty six women with voiding dysfunction directly associated with prior anti-incontinence surgery (Burch colposuspension) were included in the study (Group A). The control group (Group B) consisted of twenty eight women after Burch colposuspension with a good clinical result without LUTS. Introital ultrasound was performed at rest and at maximum voluntary contraction to measure the monitored parameters (angle alpha: the inclination angle of the urethra, angle beta: the posterior urethrovesical angle, angle gamma: the angle between the axis of the symphysis and the line segment connecting the region of the internal urethral orifice and the lower margin of the symphysis, distance H: the distance between the internal urethral orifice and the horizontal axis running through the bottom edge of the symphysis, distance p: the distance between the internal urethral orifice and the lower margin of the symphysis).

Results:
Significant differences were found in bladder neck position and mobility between those women with LUTS and control group. At a 5% confidence interval, both groups differ in mean values of the angles alpha, beta a gamma, and in the mean values of segments p and H on straining. Ventral displacement of the bladder neck (characterized by angles alpha and gamma) at rest and during straining was present in all women in group A. The difference was statistically significant (p=0,001). Angle beta also demonstrates abnormal position and minimal mobility of the bladder neck in group A. As a result of bladder neck disclocation in the ventral direction, at rest, this parameter shows significantly lower values in comparison with group B. This difference is more apparent on Valsalva, where as a result of minimal mobility of the bladder neck. This parameter has even lower values in group A in comparison with group B. The bladder neck in patients with LUTS after Burch colposuspension shows not only ventral displacement of the bladder neck but also a significant reduction in dorsocaudal movement during straining.

Conclusion:
In women with LUTS after Burch colposuspension, atypical changes in the position and mobility of urethra can be demonstrated when compared with women who underwent successful surgery for incontinence.

Key words:
introital ultrasonography, lower urinary tract symptoms, Burch kolposuspension.

Sources

1. Ulmsten, U., Henrikson, L., Johnson, P., et al. An ambulatory surgical procedure under local anesthesia for treatment of fiale inkontinence. Int Urogynecol J Pelvic Floor Dysfunct, 1996, 7(2), p. 81-85.

2. Delorme, E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary inkontinence in women. Prog Urol, 2001, 11(6), p. 1306-1313.

3. De Leval, J. Novel surgical technice for the treatment of fiale stress urinary inkontinence: transobturator vaginal tape imide-out. Eur Urol, 2003, 44, p. 724–730.

4. Nilsson, CG., Palva, K., Rezapour, M., et al. Eleven years prospective follow-up of the pension – free vaginal tape procedure for treatment of stress urinary inkontinence. Int Urogynecol J Pelvic Floor Dysfunct, 2008, 19, p. 1043-1047.

5. Latthe, PM., Foon, R., Toozs-Hobson, P. Transobturator and retropubic tape procedures in stress urinary inkontinence: a systematic review and meta-analysis of effectivness and complications. BJOG, 2007, 114(5), p. 522-531.

6. Latthe, PM., Singh, P., Foon, R., et al. Two routes of transobturator tape procedures in stress urinary inkontinence: a meta-analysis with direct and indirect comparisons of randomized trials. BJU Int, 2010 , 106(1), p. 68-76.

7. Juma, S., Sdrales, L. Etiology of urinary retention after bladder neck suspension. J Urol, 1993, 149, p. 400A.

8. Horbach, N. Suburethral sling procedures. In: Ostergard, D., Bent, A. Urogynecology and urodynamics theory and practice, 3^rd ed. Baltimore: Williams and Wilkins, pp. 413-421.

9. Burch, JC. Urethrovesical fixation to Cooper’s ligament for correctionof stress incontinence, cystocele, and prolapse. Am J Obstet Gynecol, 1961, 81, p. 281.

10. Burch, JC. Cooper’s ligament urethrovesical fixation for stress urinary incontinence. Am J Obstet Gynecol, 1968, 6, p. 764-774.

11. Tanagho, EA. Colpocystourethropexy: the way we do it. J Urol, 1976, 116, p. 751-753.

12. Viereck, V., Bader, W., Kraus, T., et al. Intra-operative introital ultrasound in Burch colposuspension reduces post-operative complications. BJOG, 2005, 112, p. 791-796.

13. DeLancey, JOL. Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol, 1994, 170, p. 1713-1720.

14. Abrams, P., Cardozo, L., Fall, M., et al. The standardisation of terminology of lower urinary tract function: Report from the standardization sub-committee of the International continence Society. Neurol Urodyn, 2002, 21, p. 167-178.

15. Bump, RC., Mattiasson, A., Bo, K. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol, 1996, 175, p. 10-17.

16. Cowan, W., Morgan, HR. A simplified retropubic urethropexy in the treatment of primary and recurrent urinary stress incontinence in the female. Am J Obstet Gynecol, 1979, 133, p. 295-298.

17. Schaer, G., Koelbl, H., Voigh, R., et al. Recommendations of the German Association of Urogynecology on functional sonography of the lower female urinary tract. Int Urogynecol J Pelvic Floor Dysfunct, 1996, 7, p. 105-108.

18. Schaer, GN., Perucchini, D., Munz, E., et al. Sonographic evaluation of the bladder neck in continent and stress-incontinent women. Obstet Gynecol, 1999, 93, p. 412-416.

19. Webster, GD., Kreder, KJ. Voiding dysfunction following cystourethropexy: its evaluation and management. J Urol, 1990, 144, p. 670-673.

20. Lukacz, ES., Lawrence, JM., Burchette, RJ., et al. The use of Visual Analog Scale in urogynecologic research: A psychometric evaluation. Am J Obstet Gynecol, 2004, 191, p. 165-170.

21. Bo, K., Talseth, T., Holme, I. Single blindt, randomised controlled trial of pelvic floor exercise, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence. BMJ, 1999, 318, p. 487-493.

22. Amarenco, G., Arnould, B., Carita, P., et al. European psychometric validation of the Contilife: a quality of life questionnaire for urinary incontinence. Eur Urol, 2003, 43, p. 391-404.

23. Bombier, L., Freeman, RM., Perkins, EP., et al. Why do women have voiding dysfunction and de novo detrusor instability after colposuspension? BJOG, 2002, 109, p. 402-412.

24. Dietz, HP., Wilson, PD. Colposuspension success and failure: a long term objective follow-up study. Int Urogynecol J Pelvic Floor Dysfunct, 2000, 11, p. 346-351.

25. Nitti, VW. Bladder outlet obstruction and retention. In Stanton, SL., Zimmern, PE. Female Pelvic Reconstructive Surgery. London: Springer Verlag, 2003, p. 326-333.

26. Abrams, P., Cardozo, L., Fall, M., et al. The standardization of terminology of lower urinary tract function: Report from the standardization sub-committee of the International Continence Society. Neurol Urodyn, 2002, 21, p. 167-178.

27. Dietz, HP., Wilson, PD., Clarke, B., Haylen, BT. Irritative symptoms after colposuspension: are they due to distortion or overelevation of the anterior vaginal wall and trigone? Int Urogynecol J Pelvic Floor Dysfunct, 2001, 12, p. 232-235.

28. Nitti, V., Tu, L., Gitlin, J. Diagnosis bladder outlet obstruction in women. J Urol, 1999, 161, p. 1535-1540.

29. Chassagne, S., Bernier, P., Haab, F., et al. Proposed cutt of values to define bladder outlet obstruction in women. Urology, 1998, 51, p. 408-411.

30. Groutz, A., Blaivas, JG., Chaikin, DC. Bladder outlet obstruction in women: definition and characteristics. Neurourol Urodyn, 2001, 19, p. 213-220.

31. Dietz, HP., Wilson. PD. Anatomical assesment of the bladder outlet and produmal urethra using ultrasound and videocystourethrography. Int Urogynecol J Pelvic Floor Dysfunct, 1998, 9, p. 365-369.

32. Schaer, GH., Koechli, OR., Schuessler, B., Halley, U. Perineal ultrasound for evaulating the bladder neck in urinary stress incontinence. Obstet Gynecol, 1995, 85, p. 220-224.

33. Petri, E., Kölbl, H., Schaer, G. What is the place of ultrasound in urogynecology? A written panel. Int Urogynecol J, 1999, 10, p. 262-273.

34. Kölbl, H., Hanzal, E. Imaging of the lower urinary tract. Curr Opin Obstet Gynecol, 1995, 7, p. 382-385.

35. Martan, A., Masata, J., Halaska, M., Voigt, R. Ultrasound imaging of the lower urinary system in women after Burch colposuspension. Ultrasound Obstet Gynecol, 2001, 17, p. 58-64.

36. Viereck, V., Pauer, HU., Bader, W., et al. Introital ultrasound of the lower genital tract before and after colposuspension: a 4-year objective follow-up. Ultrasound Obstet Gynecol, 2004, 23, p. 277-283.

37. Koelbl, H., Bernaschek, G., Deutinger, J. Assessment of female urinary inkontinence by introital sonography. J Clin Ultrasound, 1990, 18, p. 370-374.