Davila G Willy, Stanford Edward, Korn Abner
Cleveland Clinic Florida, Weston, Florida, USA.
J Am Assoc Gynecol Laparosc. 2004 May;11(2):197-203. doi: 10.1016/s1074-3804(05)60199-5.
To prospectively evaluate the use of gasless laparoscopy techniques in the performance of a traditional Burch colposuspension in women with urodynamically-demonstrated genuine stress incontinence and urethral hypermobility.
Multicenter, prospective, single-intervention series (Canadian Task Force Classification II-2).
Three urogynecologic referral centers.
Fifty-eight women.
Traditional Burch colposuspension performed utilizing gasless laparoscopic access and conventional surgical instruments.
Follow-up was 12 to 38 months. On pad testing, urine loss was significantly reduced, from 6.0 g (CI: 0.55-11.45) to 0.3 g (CI: 0-1.53). Average daily incontinence episodes based on 7-day voiding diaries decreased from 4.7 (CI: 0.87-8.53) to 0.3 (CI: 0-1.58). Q-tip angles were normalized: 49.8 degrees (CI: 40.86-58.74) to 10 degrees (CI: 1.49-18.51). Ninety-five percent of subjects reported resolution of stress incontinence. Three subjects (5%) reported recurrent/persistent genuine stress incontinence: one was operated on during the postpartum period while breastfeeding, and two developed intrinsic sphincteric deficiency postoperatively. Fifty-five percent of subjects underwent other pelvic reconstructive surgery including posterior wall repairs. Average operative time was 60.8 minutes (range, 40-92). The ideal candidate has an unscarred abdominal wall.
Gasless laparoscopic access was used to effectively perform traditional Burch colposuspension using conventional open surgical instruments. Bladder neck hypermobility was normalized in all subjects, and 95% of subjects reported no further stress incontinence.
前瞻性评估无气腹腹腔镜技术在对经尿动力学证实为真性压力性尿失禁和尿道活动过度的女性进行传统Burch阴道悬吊术中的应用。
多中心、前瞻性、单干预系列研究（加拿大工作组分类II-2）。
三个泌尿妇科转诊中心。
58名女性。
采用无气腹腹腔镜入路和传统手术器械进行传统Burch阴道悬吊术。
随访时间为12至38个月。通过护垫试验，尿失禁量显著减少，从6.0克（95%置信区间：0.55 - 11.45）降至0.3克（95%置信区间：0 - 1.53）。基于7天排尿日记的平均每日尿失禁发作次数从4.7次（95%置信区间：0.87 - 8.53）降至0.3次（95%置信区间：0 - 1.58）。棉签试验角度恢复正常：从49.8度（95%置信区间：40.86 - 58.74）降至10度（95%置信区间：1.49 - 18.51）。95%的受试者报告压力性尿失禁得到解决。3名受试者（5%）报告复发性/持续性真性压力性尿失禁：1名在产后哺乳期接受手术，2名术后出现内在括约肌缺陷。55%的受试者接受了其他盆腔重建手术，包括后壁修补术。平均手术时间为60.8分钟（范围40 - 92分钟）。理想的候选者腹壁无瘢痕。
使用无气腹腹腔镜入路，采用传统开放手术器械有效实施了传统Burch阴道悬吊术。所有受试者的膀胱颈活动过度均恢复正常，95%的受试者报告无进一步的压力性尿失禁。
