A COMPARATIVE STUDY OF BURCHCOLPOSUSPENSION AND TRANSOBTURATOR VAGINAL TAPE PROCEDURE IN WOMENWITH STRESS URINARY INCONTINENCE
J. B. SHARMA, S. TOMAR, S.KUMAR, A. SETH, A. SHARMA, K. K. ROY, N. SINGH, R. KUMARI, A.KRIPLANI;
Obstetrics & Gynecology, All India Inst. of Med.Sci. New Delhi, New Delhi, India.
Introduction: SUI is defined asinvoluntary leakage of urine with increased intraabdominal pressureand it affects quality of life in terms of social, emotional, sexualand personal aspects. It usually needs surgical treatment thoughpelvic floor exercises and medical management may be effective formild to moderate SUI.
Objective: 1. To assess the successrate with Burch colposuspension and Transobturator vaginal tapeprocedure in management of SUI. 2. To assess the post-operativecomplication rate associated with the two surgical procedures. 3. Tocompare quality of life score between the two surgical procedures. 4.To compare the levels of IL-6 and CRP in the two groups.
Methods:A total of 50 women aged 25-65 years with SUI confirmed onurodynamics were included in the study. Patients with medicaldisorders ( diabete mellitus, hypertension, cardiac disease) or mixedincontinence were excluded. Detailed history was taken, examination(general physical, abdominal and gynaecological) was performed.Urodynamic studies were performed in all cases. Evaluation of SUI wasperfomed using Kings college questionnaire. Blood samples were takenpreoperatively for CRP and IL-6 and then on the 7 th post op day.Patients were randomised in to group 1 and II by a computer generatednumber table. Patients in group1were treated by Burch colposuspensionand Tension free transobturator vaginal tape was perfomed in groupII. All patients were followed up for 6 months.
Results:Mean age was 44.0± 5.3 years in group I and 49.2 ± 10.63 years ingroup II (not significant). Mean BMI was 25.15±3.3kg/m2 in group Iand 26.15±2.09kg/m2 in group II (not significant). Mean parity was3.73 and 2.78 in the two groups respectively. Median CRP was 0.49 ingroup I and 0.54 in group II in preoperative period. The post -operative CRP was 7.05 in group I and 2.06 in group II. Preoperativemedian IL- 6 was 15.98 in group I and 8.99 in group II. PostoperativeIL-6 was 37.9 in group I and 24.3 in group II. There was significantincrease in both inflammatory markers with either operation but therewas no significant difference in the 2 groups in change ofinflammatory markers. Mean duration of surgery was 41.87±14.47minsin group I and 20.50±5.22 mins in group II(p<0.01). Post-operative catheterisation was significantly higher in Burch 115.20hrs as compared to TVT-O (26 Hrs, p<0.01). Post -operative staywas also higher in Burch 4.93±1.03 days as compared to 1.83± 0.51days in TVT-O (P<0.01). Need of post- operative analgesia was alsohigher in Burch colposuspension as compared to TVT-O. Urinaryretention was seen in 2 cases in Burch. There was significantimprovement in quality of life in both groups. Success rate was 100%in Burch and 88.9% in TVT-O.
Conclusions: Both Burchcolposuspension and TVT-O are equally effective procedures for SUI.However TVT-O is associated with lesser duration, lesser complicationrate, lesser duration of catheter and lesser hospitalstay.
References: 1. Cochrane database system review 2010;7: CD001842 2. Cochrane database system review 2009; 3: CD004742 3.Cochrane database system review 2006; 1: CD005654