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#23135

A novel method to quantify bladder neck elevation in Colposuspension. Swami S1, Hassan M2 1. Academic Urology Unit, Aberdeen Royal Infirmary, Aberdeen UK, 2. Western General Hospital Edinburgh KEYWORDS: Incontinence, Stress Urinary Incontinence, Female, Surgery Reconstructive procedures aim to restore functional and morphological changes. The relationship between the degree of anatomical correction and functional outcomes continues to be a challenging quandary in urological reconstructive surgery. Stress urinary incontinence exemplifies the relationship between the change in morphology and the subsequent change in function. Bladder neck repositioning procedures (BNRPs) provide a surgical option in treating female patients with urodynamic stress urinary incontinence. BNRPs include open Burch colposuspension, laparoscopic colposuspension and Vagino-obturator shelf procedure. BNRPs address the anatomical and functional abnormality of urethral hypermobility. The surgical principle of elevating and repositioning the bladder neck to a higher intrapelvic position optimises the pressure transmission during raised intra-abdominal pressure caused by physical activity, thereby preventing stress urinary incontinence, the hypothesis proposed by Einhorning (1). Previous studies have proved the success of colposuspension in achieving bladder neck elevation (BNE), as seen by the comparative assessment of pre and post-operative MRI scans of the pelvic floor of women undergoing colposuspension (2). Pre and post-operative studies have confirmed that colposuspension reduces bladder neck mobility and restores effective pressure transmission to the proximal urethra (3). Excessive BNE is associated with a significant incidence of voiding dysfunction and de novo detrusor overactivity. The need for an optimal level of BNE consistent with a successful outcome while minimising post-operative voiding dysfunction and de novo bladder overactivity has been recognised. There are no simple methods that can be employed to quantify the extent of bladder neck elevation achieved during BNRPs. As a corollary, it has not been possible to determine the optimum level of BNE that maximises success and minimises morbidity. The authors hypothesise that determining the optimum degree of BNE during bladder neck repositioning procedures would impact the quality of colposuspension and minimise post-operative voiding dysfunction. We also hypothesise that the potential increase in the length of the urethra might reduce the cross-sectional diameter and improve the “mucosal seal” function of the urethra. The study aims to determine the feasibility of using a catheter that can be marked to measure the degree of BNE and apply the technique as a starting point for further research that could shed light on this current knowledge gap. The bladder neck is intimately attached to the anterior vaginal wall and is elevated along with it when suspending sutures are placed between the anterolateral vaginal wall and the iliopectineal ligament during colposuspension and the obturator internus fascia in vagino-obturator shelf procedure. The elevated bladder neck, in turn, pulls the catheter balloon resting upon it to a higher position; this causes the stem of the urethral catheter to be drawn into the urethra. The extent of movement of the stem of the catheter corresponds to the extent of BNE, which can be measured. The authors describe a novel technique that enables precise measurement of the extent of bladder neck elevation achieved while performing open colposuspension. The technique has been utilised in three consecutive patients undergoing open colposuspension.