Is Prophylactic Culdoplasty Necessary at the Time of Burch Urethropexy?

Abstract

The objective of this study was to compare the incidence of genital prolapse in women undergoing Burch urethropexy for genuine stress urinary incontinence with and without prophylactic culdoplasties. The authors prospectively randomized patients who were undergoing Burch procedures for the treatment of genuine stress urinary incontinence into two groups between October 1996 and February 1999. Patients with odd medical record numbers received prophylactic culdoplasties, and patients with even medical record numbers did not receive culdoplasties. Patients were then asked to return for follow up care postoperatively at 6 weeks, 3 months, 6 months, 1 year, and yearly thereafter to be evaluated for genital prolapse. Twenty-six patients were enrolled and gave informed consent for entrance into the study. Eleven patients (42%) received culdoplasties, and 15 patients (58%) served as control subjects. One patient in the control group had an asymptomatic enterocele at her 2-year follow-up. All other patients did not have enterocele on follow-up. When the two groups were compared, there was no statistical difference between prophylactic culdoplasty and expectant management for enterocele formation (p = 1.0000). There was no statistical difference in the patient population with regard to age (p = 0.8263), parity (p = 0.5701), or menopausal status (p = 1.0000). It was concluded that Burch urethropexy does not predispose a patient to genital prolapse. Women in whom postoperative genital prolapse develops likely had the defect before surgery but did not receive the optimal corrective surgery. A thorough preoperative examination for pelvic relaxation should be performed so that corrective procedures may be performed simultaneously if needed.