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


Authors: J. Feyereisl;  L. Krofta
Authors‘ workplace: Ústav pro péči o matku a dítě, Praha, ředitel doc. MUDr. J. Feyereisl, CSc.
Published in: Čes. Gynek.2011, 76, č. 6 s. 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.


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Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
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