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Burch colposuspension vs. Stamey bladder neck suspension. A comparison of complications with special emphasis on detrusor instability and voiding dysfunction.

OBJECTIVE
To compare long-term results of Burch colposuspension and Stamey bladder neck suspension in women with genuine stress incontinence (GSI).


STUDY DESIGN
Five hundred three women with GSI underwent Burch colposuspension or a Stamey operation between 1976 and 1992. They were evaluated preoperatively and at least two years after the operations. The preoperative workup consisted of a history, pelvic examination, urine analysis and culture, cotton-tipped swab test, uroflowmetry, cystometry and urethral profilometry. Three hundred eighty-nine of 503 (77.3%) postoperative urodynamic assessments and a one-hour office pad test were performed. A questionnaire was completed by 114 patients who were not able to return to the hospital. The chi 2 and unpaired Student t test were used for statistical analysis.


RESULTS
Two hundred thirty-three complications occurred in 503 procedures, and voiding dysfunction had the highest incidence (12.1%). Detrusor instability following antiincontinence operations was detected in 45 of 389 patients (11.5%) who received follow-up urodynamic assessments at least two years postoperatively. In comparison with postoperatively stable bladders, the cystometric and uroflowmetric findings in these 45 patients revealed that the difference in urodynamic evidence of outflow obstruction was statistically significant. The Stamey operation had a statistically significantly higher incidence of postoperative voiding dysfunction as compared to Burch procedure.


CONCLUSION
In this series, detrusor instability following continence procedures might have been the consequence of established postoperative outflow obstruction.