[Guest]

After having a burch procedure in February '02 it is determined that I will need to have the sutures cut as they are holding my bladder neck up too tight. I did NOT have any form of incontinence before surgery. Will I have it after having a transvaginal urethrolysis? What exactly is done during this procedure? The doctor doing this surgery did not do the original surgery and does not do the burch procedure - do you think this is a problem?

[Guest]

Many urologists do not routinely do the Burch procedure, but are comfortable with transvaginal urethrolysis.
In such surgery a small vaginal incision is made and the urethra is dissected free and away from the sutures/scarred area from the urethropexy.
No one can predict the future re possible incontinence, but your surgeon should be able to render an opinion re such odds. I suspect they are firmly in your corner.

[quote] After having a burch procedure in February '02 it is determined that I will need to have the sutures cut as they are holding my bladder neck up too tight. I did NOT have any form of incontinence before surgery... [/quote]

[Guest]

After I have the transvaginal urethrolysis I'm assuming my bladder will fall to where it was before the burch procedure. (Before surgery, I was told I probably wasn't able to empty my bladder completely due to the position). I have been doing kegel exercises to strengthen my pelvic floor. Are any of the devices out there to help strengthen the pelvic floor muscles worth anything - do they help? Can they be harmful? Also, by cutting into the vaginal wall doesn't it weaken it?
[quote] Many urologists do not routinely do the Burch procedure, but are comfortable with transvaginal urethrolysis.
In such surgery a small vaginal incision is made and the urethra is dissected free and away from the sutures/scarred area from the urethropexy... [/quote]

[Guest]

I do not think it is probable that your “bladder will fall to where it was before the Burch procedure”, and also doubt the vaginal tissue will be significantly weakened.
Kegel’s exercises and some devices are often helpful, but may not be required.
Please follow your doctor’s advice.

[quote] After I have the transvaginal urethrolysis I'm assuming my bladder will fall to where it was before the burch procedure. (Before surgery, I was told I probably wasn't able to empty my bladder completely due to the position)... [/quote]

[Guest]

I talked with my urologist re: surgery - transvaginal urethrolysis. He talked about taking fatty tissue from labia area to prevent scarring or reattachment of urethra to front pubic area. He did not mention this before when we discussed surgery. Also said abdominal surgery could be done. I'd like less invasive surgery but want what is going to be better and less risk. What risks do you see with transvaginal urethrolysis - short and long term? Also, what about laparoscopic surgery to cut sutures?
Please answer all questions. Thank you.
[quote] I do not think it is probable that your “bladder will fall to where it was before the Burch procedure”, and also doubt the vaginal tissue will be significantly weakened.
Kegel’s exercises and some devices are often helpful, but may not be required... [/quote]

[Guest]

I do not think a laparoscopic approach would be helpful under like circumstances.
The short-term risk of urethrolysis is small. Interposing fatty tissue (a "Martius graft") is often a good idea to help prevent a recurrence (long-term risk).
Please follow your urologist’s advice.

[quote] I talked with my urologist re: surgery - transvaginal urethrolysis. He talked about taking fatty tissue from labia area to prevent scarring or reattachment of urethra to front pubic area... [/quote]