Title of article :
Randomized prospective comparison of needle colposuspension versus endopelvic fascia plication for potential stress incontinence prophylaxis in women undergoing vaginal reconstruction for stage III or IV pelvic organ prolapse, , ,
Author/Authors :
Richard C. Bump، نويسنده , , W. Glenn Hurt، نويسنده , , James P. Theofrastous، نويسنده , , W.Allen Addison، نويسنده , , J.Andrew Fantl، نويسنده , , Jean F. Wyman، نويسنده , , Donna K. McClish and The Continence Program for Women Research Group، نويسنده ,
Issue Information :
روزنامه با شماره پیاپی سال 1996
Pages :
10
From page :
326
To page :
335
Abstract :
OBJECTIVE: Severe prolapse may mask potential genuine stress urinary incontinence in women. Some have suggested that a suspending urethropexy be performed in women who have potential genuine stress incontinence demonstrated by barrier reduction of the prolapse preoperatively. Our aim was to compare outcomes after prolapse surgery that included a formal bladder neck suspension with those operations that did not. STUDY DESIGN: This prospective randomized clinical trial assigned 32 women with bladder neck hypermobility and stage III or IV pelvic organ prolapse to receive either a needle colposuspension or bladder neck endopelvic fascia plication as part of the vaginal reconstructive surgery. Twenty-nine subjects underwent detailed clinical, anatomic, urodynamic, and quality-of-life evaluations before and 6 weeks and 6 months after surgery; 23 completed urinary diary and quality-of-life evaluations after a mean of 2.9 years. RESULTS: Needle colposuspension increased short-term complications without providing additional protection from de novo stress incontinence. Barrier testing before surgery predicted urethral sphincteric resistance after surgery; however, such testing neither predicted a patientʹs function after surgery nor indicated the need for a suspending urethropexy. The combination of a needle colposuspension with a sacrospinous ligament suspension predisposed to the early development of support defects of the upper anterior vaginal segment and to failure of bladder neck support. CONCLUSIONS: Preoperative barrier testing in women with severe prolapse is not useful in identifying individuals who require a suspending urethropexy. Needle colposuspension increases short-term complications, lacks durability, and may predispose to early and severe recurrent anterior prolapse when performed with a sacrospinous ligament vault suspension. (Am J Obstet Gynecol 1996;175:326-35.)
Keywords :
Potential stress incontinence , prolapse surgery , needle bladder neck suspension , sacrospinous ligament vaginal suspension , recurrent prolapse
Journal title :
American Journal of Obstetrics and Gynecology
Serial Year :
1996
Journal title :
American Journal of Obstetrics and Gynecology
Record number :
639696
Link To Document :
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