Laparoscopic Burch Procedure

WHAT YOU SHOULD KNOW:

• 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.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• 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.

WHILE YOU ARE HERE:

Before your procedure:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• 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 (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
  
  
• 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.

• Food and drink after surgery: You will able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft food easily, you may slowly begin to eat solid foods.
  
  
• Medicines: You may need one or more of the following:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

• 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 or EKG. Sticky pads placed on your skin record your heart's electrical activity.
    
    
  • Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.
  
  
• Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.

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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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