Prediction of genital prolapse after Burch colposuspension

Objective. The aim of this prospective observational study was to investigate the gynecological and defecographic features in women with stress urinary incontinence operated with Burch colposuspension in order to analyze if the findings could predict subsequent development of genital prolapse. Subject. Twenty-one women with urodynamically proven genuine stress urinary incontinence were consecutively operated with the Burch colposuspension during 1991-1992. No concomitant prolapse repair surgery was performed. Methods. All were carefully examined in the lithotomy position at rest and with the Valsalva maneuver. The pelvic floor laxity was graded semiquantitatively. The defecography and the clinical examination were done preoperatively and repeated one year postoperatively. Results. The clinical examination revealed a significant progression of rectoceles (p=0.003) after the colposuspension. The colposuspension cured a significant number of cystoceles (p=0.035). Six women (29%) had subsequent corrective prolapse surgery median 2 years after the colposuspension. The defecographic measurements showed a significant increase of the recto-vaginal distance (RVD) following the operation (p=0.020). At the postoperative measurement the group with subsequent prolapse surgery had a significantly larger RVD as compared to the group without further surgery (p=0.004). The kappa reliability test showed poor agreement between the defecographic and clinical assessment of the rectoceles. Conclusion. We failed to find any clinical or defecographic characteristic which could predict the development of surgery-demanding genital prolapse following colposuspension. The colposuspension seemed to accelerate the deterioration of the pelvic floor. However, only a minority of the patients developed symptomatic genital prolapse demanding corrective surgery. We suggest that only women with symptomatic prolapse should be considered for concomitant corrective surgery at the time of the colposuspension.