Urinary complaints after modified Burch urethropexy: An analysis

Citations from the literature/International Journal of Gynecology & Obstetrics 51 (1995) 87-97 specificity of 77.1% for the demonstration of ‘genuine stress incontinence during cystometry, with a positive predictive value of 82% and a negative predictive value of 84.4%. Conclusions: The demonstration of urge incontinence during simple bladder filling is a reliable predictor of detrusor instability, but its absence is less reliable in excluding detrusor overactivity as a cause of urinary incontinence. Similarly, the clinical demonstration of stress incontinence during simple bladder tilling is predictive of the presence of ‘genuine’ stress incontinence during subtracted multichannel provocative cystometry. The inability to demonstrate stress incontinence during simple bladder fdling is highly correlated with the absence of ‘genuine’ stress incontinence during complex urodynamic testing. Simple bladder filling is a reliable method of diagnosing urinary incontinence. In many cases it can replace complex urodynamic testing, particularly if the proposed treatment for the condition carries a,low level of risk, and is helpful in selecting patients who need more extensive evaluation. CBnIeaI features of urinary incontinew 8nd urogenital prolapse in a black inner-fily population Peacock L.M.; Wiskind A.K.; Wall L.L. USA AM J OBSTET GYNECOL 1994 171/6 (1464-1471) Objective: Our purpose was to describe the clinical features and urodynamic findings of a black female inner-city population with urinary incontinence and uterovaginal prolapse. Study design: A retrospective review of the urogynecoloy records of 159 black female patients was performed. Results: Genital prolapse was common. A cystocele was identified in I I6 patients, a rectocele in 88 patients, and uterine or vaginal vault prolapse in 41 patients. Subtracted multichannel cystometry revealed detrusor overactivity in 58 patients, genuine stress incontinence in 44 patients, and mixed incontinence in 30 patients. Sixteen patients had normal urodynamic studies. The presence of a cystocele and the physical sign of stress incontinence at initial examination were found equally in patients with genuine stress incontinence, detrusor instability, and mixed incontinence at cystometry. There was no correlation between other commonly associated clinical factors (such as age, parity, and obesity) and the urodynamic diagnosis, Conclusions: Many of the factors commonly assumed to predispose

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women to the development of incontinence and prolapse may not apply to the black inner-city population. Urodynamic testing to establish the correct diagnosis is required, because the correlation between symptoms, physical examination, and urodynamic findings is relatively poor in this population.

Urinary ernnplalnta after modIfii Bureh urethropcxy: An anaIvsis Byck D.B.; Vamer R.E.; Clough C. USA AM J OBSTET GYNECOL 1994 171/6 (1460-1464) Objective: Postoperative bladder complaints after incontinence procedures are well known to the pelvic surgeon, but there are few reports comparing subjective complaints with objective data. Thirty of 68 patients who underwent a modified Burch urethral suspension were interviewed and examined by the tint author. Four-channel urodynamics were then performed. Study design: Of the 30 patients, eight (27%) complained of postoperative urinary leaking, and three of eight (10%) said they leaked worse than before surgery. Four patients (13%) had objective evidence of detrusor instability on cystometrogmm. Two patients (6%) had recurrent genuine stress incontinence. No patients had bladder spams or symptoms of retention. Univariate and multivariate analyses were performed on the following preoperative patient factors in relation to surgical success: age, height, hormonal status, and concurrent pelvic relaxation. Only preoperative hormone use had statistical signiticance in relation to surgical success. Results: The eight patients with leaking were treated on the basis of subjective complaints plus objective Endings. The patients with detrusor instability had improvement with medication and bladder drills, but two of the four still had mild leakage. Of the other four patients, one required a urethral sling and is now dry. The other three patients had signilicant improvement or cure of symptoms after modifications were made in their voiding techniques. Conclusion: Our study suggests that preoperative and postoperative estrogen use is significantly correlated with surgical success of. the Butch procedure, whereas age, weight, and postoperative pelvic relaxation have little influence. We also found that surgical success could be improved by close evaluation and individual management of patients with voiding complaints.