Voiding after Burch colposuspension and effects of concomitant pelvic surgery: correlation with preoperative voiding mechanism.

Abstract

To determine if concomitant abdominal hysterectomy, posterior colporrhaphy, or preoperative voiding mechanism adversely affect the duration of voiding dysfunction experienced after Burch colposuspension. A retrospective review was conducted of 154 consecutive women with genuine stress incontinence managed by Burch colposuspension over 4 years. Fifty-three (35%) women underwent colposuspension alone, 33 (22%) underwent colposuspension with posterior colpoperineorrhaphy, and 68 (44%) underwent colposuspension with total abdominal hysterectomy (TAH). A suprapubic Foley catheter was placed after all operations and removed when the post-void residual urine reached 20% or less of the volume voided on two consecutive attempts. Women who underwent colposuspension alone, colposuspension with posterior colpoperineorrhaphy, and colposuspension with TAH required a mean duration of 4.3, 4.3, and 4.8 days of postoperative bladder drainage, respectively. These differences were not statistically significant. Women who voided with Valsalva maneuver without a detrusor contraction took significantly longer to resume normal micturition than did those who voided with a detrusor contraction with or without Valsalva maneuver, or urethral relaxation alone (mean 9.0 days compared with 3.6, 4.7, and 4.8 days, respectively; P < .001). Concomitant abdominal hysterectomy or posterior colpoperineorrhaphy did not prolong voiding dysfunction after colposuspension. Women who voided with Valsalva maneuver and without a detrusor contraction took significantly longer to resume normal micturition after Burch colposuspension with or without concomitant TAH.