Laparoscopic Surgery for Urodynamic Stress Incontinence

Marie Fidela R. Paraiso

Laparoscopic Burch colposuspension is a minimally invasive alternative for the treatment of urodynamic stress incontinence. This procedure has been modified by some investigators by using mesh and staples or reducing the number of colposuspension sutures because of technical difficulty of laparoscopic suturing. At our institution, we believe that the laparoscopic Burch colposuspension should be identical to the conventional open Burch procedure. The laparoscopic access for the Burch procedure had been gaining popularity since its inception in 1991 by Van-caillie and Schuessler.1 However, with rapid adoption of the mid urethral sling procedures and their similar cure rates when compared with open colposuspension,2 more pelvic surgeons are choosing to forego the steep learning curve associated with laparoscopic suturing. Furthermore, many reconstructive pelvic surgeons prefer the vaginal route alone rather than a combined vaginal-laparoscopic or vaginal-abdominal approach for concurrent treatment of pelvic organ prolapse and stress incontinence. Surgeons who are experienced and adept at laparoscopic suturing may convert all of their pelvic reconstructive procedures, such as sacral colpopexy and paravaginal defect repairs, to the laparoscopic route, thus converting all open Burch col-posuspensions to this route.

The advantages of laparoscopic surgery are: 1) the improved visualization of anatomy of the space of Retzius and peritoneal cavity because of laparoscopic magnification, insufflation effects, and improved hemostasis; 2) shortened hospitalization; 3) decreased postoperative pain, rapid recovery, and return to work; and 4) cosmetic appearance of smaller incisions. Disadvantages of laparoscopic surgery include: 1) technical difficulty of retroperi-toneal dissection and acquiring suturing skills; 2) increased operating time early in the surgeon's experience especially if concomitant procedures are laparoscopically performed; and 3) increased hospital cost secondary to increased operating room time and the use of disposable surgical instruments.3

Constipation Prescription

Constipation Prescription

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