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.

Getting Ready

The week before your procedure:

• Ask a family member or friend to drive you home after your procedure. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using any of your present medications. These may include aspirin, ibuprofen, or blood thinners.
  
  
• Ask your caregiver before using any over-the-counter or herbal medicine or supplement. If you regularly use these medicines or supplements, tell your caregiver.
  
  
• Dye may be used during your procedure to let caregivers see your bladder better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may also be allergic to this dye. Tell your caregiver if you are allergic to any of these.
  
  
• Keep a record of the number of times you pass urine each day. You may describe the color and amount of your urine for each time you use the bathroom. Bring this record with you when you see your caregiver.
  
  
• Practice Kegel exercises, and keep doing them even after your procedure. These exercises squeeze your pelvic floor muscles and help them become stronger. Ask your caregiver for more information about Kegel exercises.
  
  
• You may need to have urine tests, cystoscopy, chest x-ray, and blood tests. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your procedure:

• Ask caregivers about directions for eating and drinking.
  
  
• Your bowel may need to be emptied and cleaned out before the procedure. Caregivers may give you a liquid medicine called an enema. This will be put into your rectum (rear end) to help empty your bowel. Your caregiver will teach you how to do this.
  
  
• You may be given a pill to help you sleep.

The day of your procedure:

• Write down the correct date, time, and location of your procedure.
  
  
• Ask your caregiver before taking any medicine on the day of your procedure. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• Do not wear contact lenses the day of your procedure. You may wear glasses. Wear socks to help you stay warm.
  
  
• If you are staying in the hospital after your procedure, bring your personal belongings with you. These include your bathrobe, toothbrush, denture cup (if needed), hairbrush, and slippers.
  
  
• Caregivers will insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your procedure. This caregiver may give you medicine to make you sleepy during your procedure.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the procedure. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.

Treatment

What will happen:

• You may be given medicine to help you relax or make you drowsy. You will be taken on a cart to the operating room and then moved into a special bed. 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.
  
  
• Caregivers may give general anesthesia to keep you completely asleep. A small incision (cut) below the umbilicus (belly button) will be done to insert the laparoscope through. Caregivers will insert other instruments by making 2 to 4 smaller incisions at different places in your abdomen. Special tools are also 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 to 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.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your appointment on time.
  
  
• You have questions or concerns about your procedure.
  
  
• You have a fever.

Seek Care Immediately if

• You feel something is bulging out into your vagina and not going back in.
  
  
• Your urine is leaking out more often than the usual.