Clinical and urodynamic characteristics of women with recurrent urinary incontinence after Burch colposuspension

Abstract

Objective: The purpose of this study was to determine the clinical and urodynamic characteristics of women with recurrent urinary incontinence after Burch colposuspension.

Material: Fifty women subjectively complaining of recurrent urinary incontinence (RUI) median 6 years after Burch colposuspension and 52 women with primary stress urinary incontinence were examined during 1991-93.

Methods: The participants were assessed with medical history, uro-gynecological examination and urodynamic investigation consisting of pad-test, urethrocystoscopy, cough provocation test, cystometry, urethra profilometry and flowmetry.

Results: Women with RUI demonstrated significantly increased incidences of recurrent lower urinary tract infection (24% vs. 8%), lumbago and sciatica (66% vs. 38%), rectocele (80% vs. 21%), and enterocele (24% vs. 0%) compared to women with primary stress urinary incontinence. Hypermobility of the bladder neck and urethra and palpable contraction of the levator ani muscles was observed significantly more often among the women with primary stress incontinence (90% vs. 42% and 83% vs. 56%, respectively). The leakage in women with RUI was significantly less pronounced than among women with primary stress incontinence. Detrusor instability was found significantly more often in women with RUI (47.51% vs. 23%). Low urethra pressure was found in five women with RUI.

Conclusion: Women with RUI after Burch colposuspension seem to have a more pronounced pelvic floor weakness than women with primary stress urinary incontinence, whereas the urinary leakage is less pronounced. Recurrent lower urinary tract infection, lumbago and sciatica as well as detrusor instability are commonly observed whereas low urethral closure pressure is rare in women with RUI after Burch colposuspension.