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Procedures

Burch Urethropexy

"Surgical fixation to nearby tissue of a displaced urethra that is causing incontinence by placing stress on the opening from the bladder"
- Merriam-Webster''s Medical Dictionary

"Surgical suspension of the urethra from the posterior surface of the pubic symphysis in order to correct urinary stress incontinence."
- The American Heritage Medical Dictionary 

"A Urethropexy is a surgical procedure where support is provided to the urethra."
- Wikipedia

Laparoscopic Burch Procedure (from: Drugs.com)

A laparoscopic Burch procedure is also known as urinary bladder suspension. This procedure is done to treat stress urinary incontinence and bladder prolapse. Stress urinary incontinence is a condition where urine leaks before you are able to reach the toilet. This is due to sudden extra pressure put on the bladder. Small amounts of urine may escape during activities, such as laughing, coughing, and sports. A bladder prolapse happens when the ligaments supporting the bladder become weak. This causes the bladder to protrude or extend into the vagina.

In a laparoscopic Burch procedure, small incisions (cuts) are made around the belly button. Caregivers will insert special tools and a laparoscope through these incisions to do the procedure. A laparoscope is a long metal tube with a light and magnifying glass on the end. During this procedure, the bladder will be pulled up into a more fixed position. Sutures (threads) are used to tie the neck of the bladder on each side to a strong ligament. This procedure will prevent the bladder from moving down, and urine from leaking during activities.

RISKS: Without treatment, you may have difficult, painful, or frequent urination, especially at night. You may continue to leak urine when coughing, sneezing, or laughing. You may also have pain when having sexual intercourse (sex). Leaking urine may be embarrassing, and affect your daily activities. If you have a prolapse, it may push the bladder out of the vaginal opening even further. This may lead to other serious medical problems.

Problems may also happen after this procedure, such as infection or bleeding. You may have problems during your procedure that may lead to a laparotomy (open surgery). Your bladder or intestines may get injured while having the procedure. After your procedure, your symptoms may only be relieved for a short time, or they may not be relieved at all. Your caregivers may need to do more procedures and watch you closely for these problems. Ask your caregiver if you are worried or have questions about your procedure, medicine, or care.

Before your procedure:

  • Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  • Enema: You may need to have an enema the morning before your procedure. This is liquid put into your rectum (rear end) to help empty your bowel. Caregivers will teach you how to do this.
  • IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  • General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.
  • Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.

During your procedure:

  • Your abdomen (stomach) and genital (vaginal) area will be cleaned with soap and water. Sheets will be put over you to keep the surgery area clean.
  • A catheter may be inserted to inject iodine dye through, and it is also used to drain your urine.
  • A small incision (cut) below the umbilicus (belly button) will be done so the laparoscope may be inserted.
  • Caregivers will insert other instruments by making 2 to 4 smaller incisions at different places in your abdomen.
  • The abdomen will then be inflated with a gas (carbon dioxide). This will allow your caregiver to view your internal organs.
  • Special tools are then used to place sutures to suspend the bladder and support the pelvic ligaments. Pelvic ligaments are strong muscle-like tissues that support the organs in the abdomen, such as the uterus and bladder.
  • A cystoscopy will be done to check for any damage in the bladder. The incisions are then closed by stitches or surgical tapes, and covered with bandages.

After your procedure:

You may be taken to a recovery room until you are fully awake. You may need to lie flat and still in bed for a few hours. Do not get out of bed until your caregiver says it is OK. If caregivers want you to stay in the hospital, you will be taken back to your hospital room. The bandages used to cover your stitches keep the areas clean and dry to prevent infection. A caregiver may remove the bandage soon after your procedure to check the incisions. Ask your caregiver for more information about ways to prevent bleeding and take care of your incisions.

Diet: You may be able to eat when bowel sounds are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope. You may be given ice chips at first, and then liquids such as water, broth, juice, or soda pop. If you do not have problems after drinking liquids, caregivers may then give you soft foods. Some examples of soft foods are ice cream, applesauce, or custard. Once you can eat soft food easily, you may begin eating your usual diet.

Medicines: You may need one or more of the following:

  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.

Monitoring: Caregivers may check for your pulses on your legs or feet. This helps caregivers learn if you have problems with blood flow after your procedure. You may also have the following:

Heart monitor: This is also called an ECG, electrocardiogram, or telemetry. Sticky pads are placed on your chest or different parts of your body. Each pad has a wire leading to a small portable box (telemetry unit), or to a TV-type screen. This lets caregivers see a tracing of the electrical activity of your heart. The heart monitor may help caregivers see problems with the way your heart is beating. Do not remove any wires or sticky pads without asking your caregiver first.

Intake and output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Certain foods also contain liquid. You may need more or less liquid each day. Ask your caregiver how much liquid you should have each day. Ask caregivers if they need to measure or collect your urine before you dispose of it.

Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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Data sources include Micromedex: [Updated 4 May 2010], Cerner Multum [Updated 22 April 2010], Wolters Kluwer [Updated 6 May 2010] and others.
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