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Órgano Oficial de el Colegio Mexicano de Urología

2006, Number 2

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Bol Col Mex Urol 2006; 21 (2)

Urachopexy: New technique of cervical suspension associated at the Burch for treatment of cystocele and stress urinary incontinence.

Serrano BEA, Lorenzo MJL, López SVA, Romo SG, Moreno AJ

Language: Spanish
References: 25
Page: 44-50
PDF size: 89.87 Kb.


ABSTRACT

Cystocele and stress urinary incontinence (SUI) are frequently associated and even though a great number of surgical techniques exist at the present time, less morbidity and better long-term outcome alternatives are still under research. The objective of this study was to compare the results in 24 months of 30 patients with SUI treated with Burch procedure (group I) vs 30 patients with SUI treated with Burch urethral and cervical suspension plus a bladder suspension technique through a high fixation of the urachus to the rectus abdominal fascia (urachopexy) (group II). Demographic parameters, degree of cystocele correction, SUI and urge urinary incontinence (UUI) improvement, alterations in bladder voiding and the morbidity rate were evaluated. In both groups a significant improvement in the degree of cystocele was achieved, nevertheless, it was superior for group II (p = 0.000). The American Urological Association prostatic symptom score decreased in both groups but without significant difference among them. SUI was resolved in 80% of the patients in group I and in 93.3% of the group II. UUI was present in 15 patients of each group before surgery and was resolved in 8 patients of group I and in 11 of group II after the procedure. Five patients in group I and 1 in group II developed de novo UUI. Maximum flow rate remained unchanged in both groups, the post-voiding residual urine and the operating morbidity did not increased significantly. Conclusions: Burch procedure plus urachopexy was superior than Burch alone in cystocele correction and long-term clinical improvement of the SUI. Surgical fixation of the urachus to the rectus abdominal fascia supports the bladder, probably decreasing its displacement during stress, and preventing tension at the cervical and urethral fixation of the Burch procedure and thus decreasing SUI recurrence.


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