Laparoscopic And Minimally Invasive Procedures continued
Laparoscopic "Paravaginal Plus Burch" Urethropexy
Dr. Miklos' and Dr. Moore's recent study review of the more than 200 patients who had received a laparoscopic Burch urethropexy revealed more than 90% of these patients also required a paravaginal repair. Dr. Miklos previously described combining these two surgical techniques in an attempt at restoring anterior vaginal wall anatomy and correcting the stress urinary incontinence. This surgical procedure is recommended for patients with cystocele (due to paravaginal defects) and stress urinary incontinence. The paravaginal repair is performed between the apex (highest point) of the anterior vaginal wall and the "bladder neck" (urethra meets the bladder) this part of the surgery corrects the cystocele (bladder drop). The Burch urethropexy is performed to stabilize and support the urethra. The combined surgical procedure routinely utilizes:
Total of ten sutures
Six sutures for the paravaginal repair (cystocele repair)
Four sutures for the Burch urethropexy (incontinence repair)
All permanent sutures
Paravaginal Repair Figure:1
Paravaginal Plus Burch Urethroplexy - Not only addresses the incontinence (Burch) but also the cystocele (paravaginal repair). Dr. Miklos and Dr. Moore have found 95% of patients receiving a Burch procedure also have paravaginal defects. Therefore, most patients should have both the Burch and paravaginal repair procedures.
Paravaginal Repair Figure:2
Burch Urethroplexy without Paravaginal repair - Note the paravaginal defects are present. The Burch procedure will adDr.ess the urine leakage, but the paravaginal defects are not addressed therefore the patient will continue with a cystocele in this area.
