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Sutures transfixing bladder as a complication of laparoscopic burch colposuspension
Epublication WebSurg.com, Sep 2016;16(09). URL: http://websurg.com/doi/vd01en4774
Laparoscopic Burch colposuspension may be difficult in cases of stress urinary incontinence (SUI) associated with large lateral cystocele. In these cases, complications may occur. However, they are rare. This video shows the cystoscopic treatment of intravesical adhesions, secondary to sutures transfixing the bladder during the Burch laparoscopic procedure and lateral suspension, without perioperative use of control cystoscopy. An office cystoscopy was performed after the operation, nine months later, because of gradual onset of entirely isolated pelvic pain at the end of urination. It showed intravesical synechia as bilateral pillars. The different steps of the operation are the following: 1) Diagnostic laparoscopy with a good status of the lateral suspension without mesh migration. 2) Operative laparoscopy with opening of Retzius’s space, dissection, adhesiolysis, and division of the non-absorbable sutures of the past colposuspension in order to mobilize the bladder, followed by reperitonization of Retzius’s space. 3) Diagnostic cystoscopy confirming adhesions as bilateral pillars, laterally to the trigone with normal ejaculation of both ureteral ostia. 4) Operative cystoscopy after catheterization of both ureters: division of the pillars with the monopolar electrode without visualization of the Burch sutures, as they probably migrated upward in the first postoperative months. In the postoperative period, ureteral catheters are removed 48 hours after surgery. Pain resolves completely during urination. Normal kidneys and ureters are observed at ultrasound. This video clearly demonstrates the advantages related to the routine use of cystoscopy at the end of the laparoscopic Burch procedure, especially in cases of large lateral cystocele.