Analysis of the Success Rates of Burch Colposuspension in Relation to Valsalva Leak-Point Pressure

Abstract

OBJECTIVE: To compare the success rates of Burch colposuspension in relation to a Valsalva leak-point pressure (VLPP) cutoff level of 60 cm H2O and to examine other predictive factors for intrinsic sphincter deficiency, such as maximal urethral closure pressure (MUCP) and functional urethral length (FUL), in an attempt to define the urodynamic contraindications to Burch colposuspension. STUDY DESIGN: From March 1999 to February 2001, among patients who had undergone Burch colposuspension after being diagnosed as having stress urinary incontinence at the Yonsei University Medical Center Urogynecology Clinic, 79 patients eligible for continuous postoperative follow-up were enrolled in the study. Patients with past histories of hysterectomy and/or incontinence surgery were excluded from the study, and all patients included in the study had pelvic organ prolapse stage II or less. Urodynamic studies were performed as a preoperative evaluation, and recurrence of stress urinary incontinence after surgery was diagnosed through thorough history and meticulous urodynamic evaluations. RESULTS: The mean age was 57.66 +/- 9.99 years, mean parity was 3.71 +/- 4.38, menopausal rate and mean age at menopause were 81.0% (64 of 79) and 50.31 +/- 4.60 years, respectively, and the proportion of patients receiving hormone replacement therapy was 10.1% (8 of 79). The success rates in 2 groups, VLPP > or = 60 cm H2O (n=55) and < 60 cm H2O (n=24) were 94.55% and 91.67%, respectively, demonstrating no statistical significance (p > 0.05). The MUCP and FUL values were within normal ranges in both groups (MUCP, 66.98 +/- 24.04 versus 66.23 +/- 22.89 cm H2O, p>0.05; and FUL, 36.33 +/- 7.31 versus 38.71 +/- 8.54 mm, p > 0.05), without a significant difference. The Pearson correlation coefficients for VLPP versus MUCP and VLPP versus FUL were 0.50 (p < 0.001) and 0.57 (p < 0.001), respectively, demonstrating a significant positive correlation. CONCLUSION: A VLPP level < 60 cm H2O does not represent an absolute contraindication to Burch colposuspension, provided that other parameters, such as MUCP and FUL, are within acceptable ranges. To select appropriate candidates for Burch colposuspension, a comprehensive evaluation of urodynamic parameters is mandatory.