Abstract
The aim of this study was to define the concept of hypermobility of the bladder neck and determine its effects on the cure rate and postoperative complications in patients undergoing colposuspension. In a retrospective study, 310 patients who underwent primary colposuspension for urodynamically proven genuine stress urinary incontinence were assessed by introital ultrasound before surgery and during follow-up for up to 48 months postoperatively. A total of 152 women completed 48 months of follow-up. Mobility of the bladder neck during straining was described as linear dorsocaudal movement (LDM) with LDM >15 mm being defined as hypermobility. The overall objective cure rate was 90.0% at 6-month follow-up vs 76.8% at 48-month follow-up (Kaplan–Meier estimators). Urge symptoms occurred in 12.6% (39/310) of the women and de novo urge incontinence in 2.3% (7/310). Bladder neck hypermobility was significantly reduced after anti-incontinence surgery, from 67.1% (208/310) before surgery to 5.5% (17/310) immediately after surgery (P<0.0001). Postoperative hypermobility was associated with a higher recurrence rate. In the hypermobility group, 52.9 and 34.0% of the patients were continent for up to 6 and 48 months, respectively, as opposed to 92.2 and 79.2% in the group without hypermobility (P<0.0001). Women with postoperative hypermobility had a 3.2-fold higher risk of recurrence within 48 months. Bladder neck hypermobility after surgery was also associated with postoperative voiding difficulty (P=0.0278). Patients in whom hypermobility of the bladder neck diagnosed before surgery persists after colposuspension have a higher risk of recurrence and are more likely to develop postoperative complications than those without this hypermobility.
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References
Enhorning G (1960) Closing mechanism of the female urethra. Lancet 275:1414
Enhorning G (1976) A concept of urinary continence. Urol Int 31:3–5
Crystle CD, Charme LS, Copeland WE (1971) Q-tip test in stress urinary incontinence. Obstet Gynecol 38:313–315
Karram MM, Narender NB (1988) The Q-tip test: standardization of the technique and its interpretation in women with urinary incontinence. Obstet Gynecol 71:807–811
Klutke JJ, Carlin BI, Klutke CG (2000) The tension-free vaginal tape procedure: correction of stress incontinence with minimal alteration in proximal urethra. Urology 55:512–514
Bader W, Degenhardt F, Kauffels W, Nehls K, Schneider J (1995) Sonomorphologische Parameter der weiblichen Stressharninkontinenz. Ultraschall Med 16:180–185
Vierhout ME, Hol M (1998) Vaginal ultrasound studies before and after successful colposuspension and in continent controls. Acta Obstet Gynecol Scand 77:100–104
Brandt FT, Albuquerque CD, Lorenzato FR, Amaral FJ (2000) Perineal assessment of urethrovesical junction mobility in young continent females. Int Urogynecol J 11:18–22
Peschers UM, Fanger G, Schaer GN, Vodusek DB, DeLancey JO, Schuessler B (2001) Bladder neck mobility in continent nulliparous women. BJOG 108:320–324
Reed H, Freeman RM, Waterfield A, Adekanmi O (2004) Prevalence of bladder neck mobility in asymptomatic non-pregnant nulliparous volunteers. BJOG 111:172–175
Dietz HP, Eldridge A, Grace M, Clarke B (2003) Normal values for pelvic organ descent in healthy nulligravid young Caucasian women. Neurourol Urodyn 22:420–421
Tunn R, Petri E (2003) Introital and transvaginal ultrasound as the main tool in the assessment or urogenital and pelvic floor dysfunction: an imaging panel and practical approach. Ultrasound Obstet Gynecol 22:205–213
Dietz HP (2004) Ultrasound imaging of the pelvic floor. Part I: two-dimensional aspects. Ultrasound Obstet Gynecol 23:80–92
Tunn R, Schaer G, Peschers U, Bader W, Gauruder A, Hanzal E, Koelbl H, Koelle D, Perucchini D, Petri E, Riss P, Schuessler B, Viereck V (2005) Updated recommendations on ultrasonography in urogynecology. Int Urogynecol J Pelvic Floor Dysfunct 16:236–241
Viereck V, Pauer HU, Bader W, Oppermann M, Hilgers R, Gauruder-Burmester A, Lange R, Viereck N, Emons G, Hackenberg R, Krauss T (2004) Introital ultrasound of the lower genital tract before and after colposuspension: a 4-year objective follow-up. Ultrasound Obstet Gynecol 23:277–283
Viereck V, Bader W, Skala C, Gauruder-Burmester A, Emons G, Hilgers R, Krauss T (2004) Determination of bladder neck position by intraoperative introital ultrasound in colposuspension: outcome at 6-month follow-up. Ultrasound Obstet Gynecol 24:186–191
Kil PJ, Hoekstra JW, van der Meijden AP, Smans AJ, Theeuwes AG, Schreinemachers LM (1991) Transvaginal ultrasonography and urodynamic evaluation after suspension operations: comparison among the Gittes, Stamey and Burch suspensions. J Urol 146:132–136
Schaer G, Koelbl H, Voigt R, Merz E, Anthuber C, Niemeyer R, Ralph G, Bader W, Fink D, Grischke E, Hanzal E, Koechli OR, Koehler K, Munz E, Perucchini D, Peschers U, Sam C, Schwenke A (1996) Recommendations of the German Association of Urogynecology on functional sonography of the lower female urinary tract. Int Urogynecol J Pelvic Floor Dysfunct 7:105–108
Bader W, Schwenke A, Leven A, Schüβler M, Hatzmann W (1997) Methodischer Ansatz zur Standardisierung der Introitussonographie. Geburtshilfe Frauenheilkd 57:193–197
Dietz HP, Wilson PD (2000) Colposuspension success and failure: a long-term objective follow-up study. Int Urogynecol J Pelvic Floor Dysfunct 11:346–351
Eriksen BC, Hagen B, Eik-Nes SH, Molne K, Mjolnerod OK, Romslo I (1990) Long-term effectiveness of the Burch colposuspension in female urinary stress incontinence. Acta Obstet Gynecol Scand 69:45–50
Feyereisl J, Dreher E, Haenggi W, Zikmund J, Schneider H (1994) Long-term results after Burch colposuspension. Am J Obstet Gynecol 171:647–652
Jarvis GJ (1994) Surgery for genuine stress incontinence. Br J Obstet Gynaecol 101:371–374
Alcalay M, Monga A, Stanton SL (1995) Burch colposuspension: a 10–20 year follow up. Br J Obstet Gynaecol 102:740–745
Hol M, van Bolhuis C, Vierhout ME (1995) Vaginal ultrasound studies of bladder neck mobility. Br J Obstet Gynaecol 102:47–53
Kobata SA, Girao MJ, Sartori MG, Baracat EC, Rodrigues de Lima G (1999) Urodynamic and ultrasonographic evaluation after continence surgery. Int Urogynecol J Pelvic Floor Dysfunct 10:321–324
Cowan W, Morgan HR (1979) A simplified retropubic urethropexy in the treatment of primary and recurrent urinary stress incontinence in the female. Am J Obstet Gynecol 133:295–298
Skala C, Emons G, Krauβ T, Hilgers R, Gauruder-Burmester A, Lange R, Bader W, Viereck V (2004) Postoperative funneling after anti-incontinence surgery—a prognostic indicator?—Part 1: colposuspension. Neurourol Urodyn 23:636–642
Abrams P, Blaivas JG, Stanton SL, Andersen JT (1990) The standardisation of terminology of lower urinary tract function. The International Continence Society Committee on Standardisation of Terminology. Br J Obstet Gynaecol 97:1–16
Dietz HP, Clarke B, Herbison P (2002) Bladder neck mobility and urethral closure pressure as predictors of genuine stress incontinence. Int Urogynecol J 13:289–293
Kelleher CJ, Cardozo LD, Khullar V, Salvatore S (1997) A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol 104:1374–1379
Hodgkinson CP (1953) Relationships of the female urethra in urinary incontinence. Am J Obstet Gynecol 65:560–573
Versi E, Lyell D, Griffiths D (1998) Videourodynamic diagnosis of occult genuine stress incontinence in patients with anterior vaginal wall relaxation. J Soc Gynecol Investig 5:327–330
Schick E, Dupont C, Bertrand PE, Jolivet-Tremblay M, Tessier J (2004) Predictive value of maximum urethral closure pressure, urethral hypermobility and urethral incompetence in the diagnosis of clinically significant female genuine stress incontinence. J Urol 171:1871–1875
Barbic M, Kralj B (2000) Effect of intra-abdominal position of the bladder neck and stability of its supporting structures on pressure transmission ratio after colposuspension. Int Urogynecol J Pelvic Floor Dysfunct 11:97–102
Bombieri L, Freeman RM (2003) Do bladder neck position and amount of elevation influence the outcome of colposuspension? Br J Obstet Gynaecol 110:197–200
Bombieri L, Freeman RM, Perkins EP, Williams MP, Shaw SR (2002) Objective assessment of bladder neck elevation and urethral compression at colposuspension. Br J Obstet Gynaecol 109:395–401
Bombieri L, Freeman RM, Perkins EP, Williams MP, Shaw SR (2002) Why do women have voiding dysfunction and de novo detrusor instability after colposuspension? Br J Obstet Gynaecol 109:402–412
Martan A, Masata J, Halaska M, Voigt R (2001) Ultrasound imaging of the lower urinary system in women after Burch colposuspension. Ultrasound Obstet Gynecol 17:58–64
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Viereck, V., Pauer, HU., Hesse, O. et al. Urethral hypermobility after anti-incontinence surgery—a prognostic indicator?. Int Urogynecol J 17, 586–592 (2006). https://doi.org/10.1007/s00192-006-0071-4
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DOI: https://doi.org/10.1007/s00192-006-0071-4