Feasibility of and interest in laparoscopic assessment in recurrent urinary stress incontinence after Burch procedure performed by laparotomy.

Background: The Burch colposuspension, performed by laparotomy or laparoscopy, remains one of the most popular operations for the treatment of genuine stress incontinence. The average failure rate is 10% in patients followed up for 5 years or more in the literature. The etiology of the failure is difficult to assess by clinical or urodynamic investigations; the failure may be due to weak sutures on the Cooper's ligaments or on the vagina, to excessive or insufficient elevation of the cervical neck, or to an incompetent urethral sphincter.

Methods: The authors performed five preperitoneal laparoscopies for recurrent urinary stress incontinence in women after a colposuspension performed by laparotomy in order to determine the etiology of the recurrence (between 1992 and 1995 at the Department of Gynecology of the University Hospital of Caen, France).

Results: Laparoscopic preperitoneal access was possible in all patients. No laparotomy had to be performed. One small bladder injury occurred during the dissection. It was sutured by laparoscopy. There were no postoperative complications. In one patient, both of the sutures had escaped. In two other patients both sutures were found in place, but urodynamics showed a decrease in closure pressure. In two other patients, complaining of dysuria (painful voiding and acute bladder distension) associated with urinary leakage, only the colposuspension on one side had failed, involving a lateral torsion of the bladder neck.

Conclusion: Preperitoneal laparoscopy is feasible after a laparotomic colposuspension and gives a very interesting etiologic contribution to the recurrence of incontinence. It helps to choose the most appropriate procedure to treat these recurrent incontinent patients: a new colposuspension if the previous one has failed anatomically and a sling operation if it hasn't and if the sphincter is incompetent.