WOMENS-HEALTH Messages for January, 2001: Re: Is burch procedure w/ hyst really worth it?

Re: Is burch procedure w/ hyst really worth it?

From: Lynn D. Montgomery, MD (anonymous@obgyn.net)
Thu, 4 Jan 2001 11:01:31 -0600 (CST)

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In reply to: Maria: "Is burch procedure w/ hyst really worth it?"

At Thu, 4 Jan 2001, Maria wrote: >
>I am scheduled to undergo a vaginal hysterectomy (keeping ovaries
>intact) at the end of this month. I mentioned to my ob/gyn that I have
>a little leakage when I sneeze, so if she could tighten up some
>ligaments around my bladder,I thought it would be great. She said she'd
>have to first conduct a special test on me to determine by bladder
>control, and if she found it to be weak, she could perform a burch
>during my hysterectomy. The only problem is she would have to do it
>laproscopically. Since I'm lucky enough to be able to have my hyst done
>vaginally, I told her I'd prefer to skip the abdominal incisions of a
>burch altogether. Am I making a mistake? (P.S. She originally told me
>that my enlarged uterus is pressing against my bladder during a sneeze,
>resulting in minor leakage. With the uterus gone, I imagine the bladder
>wouldn't be pressing against anything during a sneeze, right?)

Maria, First, I think that it is very important to do the bladder test. This will help delineate how much of a problem there is and exactly what kind of problem is causing the urine loss. Second, the uterus may be contributing to the urine loss if the size and position are right. However, with sneezing or any straining, there is an increase in intra-abdominal pressure, which causes pressure on the bladder and can result in urine loss, even without the uterus in place. Thus, if there is a problem, you want it fixed. Further, urinary incontinence tends to progress insidiously with age. Third, there are other options for a repair that do not require any abdominal incision. You may want to discuss vaginal approaches with your physician. Often, when doing a vaginal hysterectomy, gynecologists will perform an anterior repair, which consists of tightening the anterior vaginal wall to support the bladder, with the addition of a stitch that particularly lifts the area of the bladder that is causing the problem with "stress" (sneezing) incontinence. This is a very common procedure and may be all you need... Lynn

--
Lynn D. Montgomery, MD
Director, Maternal-Fetal Medicine
Rocky Mountain Perinatal Center
Missoula, Montana

**Note:  Opinions expressed here are for educational purposes only and, as such, do not constitute a physician-patient relationship.  This information is not intended to supplant the need for you to consult with your physician prior to choosing therapeutic options and/or interventions.

**Private e-mails cannot be entertained due to time constraints, consequently no private e-mails will receive a response.

**Thank you for your understanding ;-)

Next message: Lynn D. Montgomery, MD: "Re: Premarin cream and possible pregnancy"
Previous message: mary: "tubal reversal"
In reply to: Maria: "Is burch procedure w/ hyst really worth it?"

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