Is Cystoscopy Unwarranted, Following Burch Procedures?

HOT SPRINGS, VA. -- Rou tine intraoperative cystoscopy to identify lower urinary tract in juries caused during Burch procedures adds time and expense and is not warranted, Dr. Edward J. Gill said.

In recent years, findings from several studies showing that intraoperative cystoscopy increases the rate of detecting lower urinary tract injuries have prompted investigators to conclude that cystoscopy should be performed after every pelvic reconstructive and incontinence procedure that would put the region at risk.

However, such broad advice appears to be unnecessary in the context of Burch procedures, Dr. Gill said at the annual meeting of the South Atlantic Association of Obstetricians and Gynecologists.

In a retrospective study, Dr. Gill and his colleagues at Virginia Commonwealth University, Richmond, reviewed the records of 30 women who had the Burch procedure for stress urinary incontinence and 151 women who underwent the Burch procedure plus additional pelvic surgery. All the women had intraoperative cystoscopy performed at completion of the Burch procedure after intravenous indigo carmine dye was administered.

They found a total of six (3.3%) injuries to the lower urinary tract. Of those, five were cystotomies that had been recognized intraoperatively before the cystoscopy had been performed.

The remaining injury was at tributed to a concomitant paravaginal repair, not the Burch procedure. There were no known late presentations of lower urinary tract injury.

"Although cystoscopy ...