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Introduction. Burch colposuspension is still estimated as a 'gold standard' by the Cochrane Collaboration Group in the treatment of operative stress urinary incontinence (SUI) Some urogynecologists agree with this statement, some argue that Burch colposuspension should no longer be used. Objective. The aim of this study was to evaluate mid-term effects and patient's satisfaction with standardized modified colposuspension performed in one centre. Material and methods. Modified colposuspension was performed after standardization by 2 trained gynaecologists in 354 women. Data collected from 227 women were added to the final analysis of mid-term results. Average time from the operation to mid-term visit was 19 months (range 9-36 months). Results. At mid-term visit, 86.3% of patients were cured. There was no case of post-void urine residual over 100 ml. Pain near the operated region was reported by 1 woman from agricultural region. No one reported negative impact of modified colposuspension on sexual activity or dyspareunia. Conclusions. Modified colposuspension according to the E. Petri technique seems to be an operation that is safe and well-tolerated by women with preoperative stress urinary incontinence and paravaginal defect without urodynamic signs of ISD in mid-term observation. [ABSTRACT FROM AUTHOR]

Stress urinary incontinence occurs when the support structures of the pelvic floor and the urinary system are stretched, damaged, or defective. This condition is common in women of all ages, and billions of dollars are spent each year to correct the condition and improve quality of life. This article reviews three current treatments for stress urinary incontinence: the Burch colposuspension procedure, urethral slings, and radiofrequency treatments. In one study, researchers reported that patient satisfaction rates were higher for the Burch procedure than for urethral sling procedures. Other researchers found that urethral sling procedures had high rates of success but that adverse events were more common. Adverse events for both types of procedures include voiding difficulties, postoperative urge incontinence, and urinary tract infections. Radiofrequency interventions can improve the quality of life for many patients and can provide a short-term intervention for many patients who later may require a more-invasive surgical procedure. [ABSTRACT FROM AUTHOR]

Approximately 16–29% of women will complain of incontinence at the menopause. A multidisciplinary approach to treatment is essential and surgery is usually reserved for women who have failed to improve sufficiently with conservative measures, such as pelvic floor exercises. The Burch colposuspension remains the 'gold standard' procedure for stress urinary incontinence, against which all newer procedures are compared. It is normally carried out under general anaesthesia and requires an abdominal approach, most often by a low transverse incision. Tension-free vaginal tape (TVT) is the most popular procedure at present and has largely replaced colposuspension in many units. However, there are concerns about both its long-term safety and the lack of data on efficacy beyond the first few years. Initial reports of transobturator tape suggest that it may have a similar efficacy to TVT but with a lower rate of serious complications; however, large comparative studies and longterm follow-up data are currently unavailable. Collagen and silicone injected around the urethra can be used in a selected group of patients under local anaesthetic but the success rates are disappointingly low. [ABSTRACT FROM AUTHOR]

The purpose of this study was to use magnetic resonance imaging to observe the changes of the position of the levator ani muscle relative to the bladder neck after Burch colposuspension. Of the 73 women who were studied, only 28 women were included m the study because the medial edge of the levator ani was visible clearly on u parasagittal magnetic resonance image. At the l-year follow-up, the objective cure rate was 86%. Measures of bladder neck and levator ani position in relation to the pubococcygeal line were found to be reproducible. Burch colposuspension produces a significant elevation of the levator ani. with a reduced distance between the bladder neck and the levator ani muscle. Surgical success was associated significantly with a shorter distance between bladder neck and levator ani muscle. The anatomy of the levator ani muscle is changed by colposuspension. The apposition of the levator ani muscle to the bladder neck may play a role in the restoration of continence. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to compare Burch colposuspension and paravaginal repair for success rates, complications, and urodynamic effects when the procedures are used in the treatment of stress urinary incontinence.Study Design: Thirty-six patients were enrolled. A full urodynamic evaluation was repeated 6 months postoperatively.Results: Twelve (67%) and 17 (94%) subjects (Burch colposuspension vs paravaginal repair) voided spontaneously before discharge (p = 0.04). One patient receiving the Burch procedure underwent urethral dilation for urinary retention. Follow-up was for 1 to 3 years. Differences in subjective and objective cure rates favored the Burch colposuspension over the paravaginal repair: 100% versus 72% (p = 0.02) and 100% versus 61% (p = 0.004), respectively. The paravaginal repair did not produce significant modifications in profilometry. Postoperatively, cotton swab tests had negative results in all patients with the Burch operation and in 33% of those with the paravaginal repair (p = 0.01).Conclusion: Paravaginal repair is not recommended for the treatment of stress incontinence, although it was accompanied by a more immediate resumption of voiding. [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to evaluate the cost-effectiveness of Burch colposuspension compared with tension-free vaginal tape. Study Design: A Markov decision model was developed to compare costs (2005 US dollars) and effectiveness (quality-adjusted life years) of Burch and tension-free vaginal tape for stress urinary incontinence over 10 years from a health care system perspective. After surgery, outcomes included cure, persistent stress urinary incontinence followed by second surgery, and persistent stress urinary incontinence and mesh erosion after tension-free vaginal tape. An incremental cost-effectiveness ratio of less than $50,000 per quality-adjusted life year was considered cost-effective. Results: For the base-case, the Burch strategy cost more than tension-free vaginal tape ($9320 vs $8081), but was slightly more effective (7.260 vs 7.248 quality-adjusted life years). The incremental cost-effectiveness ratio was $98,755 per quality-adjusted life year. The incremental cost-effectiveness ratio was less than $50,000 per quality-adjusted life year when the relative risk of cure after Burch to tension-free vaginal tape was greater than 1.09. Conclusion: Burch colposuspension was not cost-effective compared with tension-free vaginal tape. However, if the tension-free vaginal tape failure rate was to increase over time, Burch may become cost-effective. [Copyright &y& Elsevier]