2 results
14 - PELVIC FLOOR
- Camran Nezhat, Stanford University School of Medicine, California, Farr Nezhat, Mount Sinai School of Medicine, New York, Ceana Nezhat
-
- Book:
- Nezhat's Operative Gynecologic Laparoscopy and Hysteroscopy
- Published online:
- 23 December 2009
- Print publication:
- 07 July 2008, pp 366-424
-
- Chapter
- Export citation
-
Summary
Retropubic Burch colposuspension has been considered by many to be the “gold standard” procedure for the treatment of female stress urinary incontinence for almost 40 years. Vancaillie and Schuessler introduced the laparoscopic approach to retropubic colposuspension in 1991. Numerous reports followed in subsequent years describing laparoscopic colposuspensions and their efficacy. Analysis of the outcomes of these various laparoscopic “Burch” colposuspensions is difficult because many of the techniques are not true Burch procedures but rather other modified retropubic colposuspensions. In this section, we describe the laparoscopic Burch colposuspension, including patient selection, preoperative evaluation, operative technique, possible complications, and efficacy. We review the efficacy of the laparoscopic Burch colposuspension studies that use the Burch—Tanagho procedure and compare these techniques to other popular anti-incontinence procedures. The many modified laparoscopic retropubic procedures are not addressed.
BURCH COLPOSUSPENSION: THE EVOLUTION OF A PROCEDURE
In 1961, Burch published the description of a new female anti-incontinence procedure, based on a technique started in 1958. The technique involved entering the space of Retzius via a paramedian incision. After clearing the periurethral tissue of its overlying fat and areolar tissue, three 2-0 chromic sutures were placed at the mid-urethra and the bladder neck and then fixed to Cooper's ligament. Burch reported a subjective cure rate of 92% in 143 patients with 10 to 60 months of followup.
21 - ADDITIONAL PROCEDURES FOR PELVIC SURGEONS
- Camran Nezhat, Stanford University School of Medicine, California, Farr Nezhat, Mount Sinai School of Medicine, New York, Ceana Nezhat
-
- Book:
- Nezhat's Operative Gynecologic Laparoscopy and Hysteroscopy
- Published online:
- 23 December 2009
- Print publication:
- 07 July 2008, pp 537-551
-
- Chapter
- Export citation
-
Summary
Cystoscopy, the gold standard for diagnosis of disorders and injuries of the lower urinary tract, provides another tool for prevention and active management of urologic pathology and surgical complications by allowing the surgeon to assess the integrity and function of the urethra, bladder, and ureters. At our center, we have incidentally detected bladder endometriosis, polyps, malignant lesions, diverticula, duplicated ureter, and interstitial cystitis. One case of complete ureteral obstruction and renal necrosis due to invasive endometriosis was detected during an incidental cystoscopy. Contralateral periureteral disease was treated, resulting in successful conservation of the other kidney.
Cystoscopic technique, unfortunately, is not routinely taught during obstetrics/gynecology residency training; therefore, many gynecologists do not feel comfortable performing the procedure. This is unfortunate as gynecologists deal with urogynecologic issues daily with conditions such as urinary incontinence, pelvic organ prolapse, and severe endometriosis involving the lower urinary tract. Two large multicenter studies demonstrated that 66% to 80% of patients with chronic pelvic pain had evidence of bladder-origin pain due to bladder epithelial damage or interstitial cystitis. In the gynecologic literature, chronic pelvic pain is associated with endometriosis in 30% to 87% of cases as well. The surgical treatment of pelvic pain is the most frequent indication for operative laparoscopy, although in as many as 40% of patients, no pathology is found.