4. Colposuspension:
| a. | is normally done as a vaginal procedure | False |
| b. | gives better results that urethral buttressing for pure stress incontinence | True |
| c. | is effective in relieving urge incontinence. | False |
| d. | is effective in relieving dyspareunia. | False |
| e. | is associated with an increased incidence of posterior vaginal wall prolapse | True |
| f. | can be done via the laparoscope | True |
See also MCQ Paper 5, question 37.
Colposuspension is usually performed abdominally.
The laparoscopic approach is difficult and has a question mark over its longevity.
Colposuspension is very effective in dealing with uncomplicated stress incontinence.
It has been the "gold standard".
Urge incontinence, frequency and nocturia suggest bladder instability and colposuspension will usually make no difference.
About 5% develop bladder instability de novo after colposuspension.
Most prefer it to incontinence.
Most patients who used to have colposuspension are now having TVT, TOT or equivalent.
In TVT a tape is inserted underneath the urethra with the ends being passed up each side of the urethra behind the pubic bone.
It thus forms a "U" shape and provides support to the bladder neck and proximal urethra during increased intra-abdominal pressure.
It seems to be roughly as effective and durable as colposuspension, with similar incidences of bladder instability and urinary retention.
Its great virtue is that it is easier and quicker and the patient goes home earlier, usually within 24 hours.
TVT was the first of such procedures on the market, but is now being challenged by alternatives like TOT that are technically easier
- see MCQ Paper 11, question 44.
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