Gynecol Obstet Invest 1990;29;239—240 © 1990 S. Karger AG, Basel 0378-7346/90/0293-023952.75/0 Ureteral Blockage as a Complication of Burch Colposuspension: Report of 6 Cases Rui Alberto Ferriani, Marcos Felipe Silva de Sá, Marcos Dias de Moura, Melhem Naim Charajfedine, Antonio Hockgreb de Freitas Júnior Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeiráo Preto, University of Sao Paulo, Ribeiráo Preto, SP, Brazil Key Words. Burch procedure • Ureteral obstruction • Stress incontinence Abstract. Burch colposuspension for correction of urinary incontinence is rarely followed by complications. A very rarely described complication is ureteral kinking, which tends to occur in patients with previous pelvic surger ies. We present 6 additional cases of this rare complication and recommend appropriate intraoperative dissection as well as postoperative alert for early diagnosis, which improves prognosis. Introduction Urinary stress incontinence is a symptom occurring rather frequently in clinical gynecology, usually among women with relaxation of the anterior portion of the pel vic and urogenital diaphragms and of the aponeurotic supports. Urethrovaginal fixation to Cooper’s ligament, first described by Burch in 1961 [1], is a technique com monly used to correct this symptom. The long-term cure rate is 85-90% [2] and the procedure has a low rate of major complications. Ureteral blockage is rare and has been reported thus far on 2 occasions as a consequence of ureteral kinking after colposuspension [3, 4], In the present paper we report 6 cases of this unusual compli cation, which may have serious consequences for the patient if not diagnosed early. Case Reports A total of 483 patients were submitted to Burch colposuspension at the Department of Gynecology and Obstetrics, University Hospi tal of Ribeirâo Preto, University of Sâo Paulo, over a period of 5 years. All of these patients presented urinary stress incontinence, small urethrocele and minimal cystocele. Urinary stress inconti nence was diagnosed on the basis of medical history, physical exam ination, full-bladder stress test, contrasted X rays of the bladder and, when possible, urodynamic study. The surgical technique used consisted of bilateral vaginal fundus suspension to Cooper’s liga ment with 3 No. 0 vicryl sutures under moderate tension. There were no intraoperative complications. Of the 483 patients, 4 had immediate or delayed postoperative lumbar pain and 2 were anuric on the 1st postoperative day. The clinical data concerning these patients are presented in table 1. The 6 patients were diagnosed to have ureteral blockage on the basis of intravenous pyelography and cystoscopy. Each patient was submit ted to further surgery for removal of sutures that caused ureteral kinking unilaterally (cases 1,2 and 3) or bilaterally (cases 4, 5 and 6), with intraoperative cystoscopic control. Control intravenous pyel ography performed in each case was normal. An early complication was reversible acute renal infection in 1 patient. A delayed compli cation was continued urinary stress incontinence in 2 patients (cases 2 and 4). Conclusions Burch colposuspension has been widely used to treat urinary stress incontinence. The cure rate ranges from 85 to 90% and the incidence of complications is low,