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INTRODUCTION AND OBJECTIVES:The need for long-term follow up data in female patients undergoing surgery for stress urinary incontinence (SUI) has been repeatedly highlighted by Cochrane reviews and the FDA. This is especially relevant in the current climate of controversy over the safety of mesh-related products. We aimed to assess the subjective long-term outcomes of patients who had undergone SUI surgery at our institution in this real-world study.METHODS:All female patients who underwent SUI surgery at one institution from January 2011 to December 2016 were identified and sent a 5-item self-administered postal questionnaire. Results were analysed using GraphPad Prism 6.0.RESULTS:Questionnaires were returned by 364 of 570 patients identified (64% response rate), with a median age of 51 (range 17–84) and mean follow up of 54 months. The majority of respondents underwent TOT insertion (79%), followed by TVT (17%), autologous sling (2%) and Burch colposuspension (2%). 94% of procedures were primary (6% rev...

Objectives The prevalent use of minimally invasive midurethral slings for the treatment of stress urinary incontinence in the last several decades has resulted in fewer Burch procedures being performed and diminished surgical experience in performing the Burch colposuspension. However, recent antimesh media has resulted in more patients requesting nonmesh anti-incontinence procedures and a subsequent need for surgeons to refamiliarize themselves with the Burch procedure and its relevant anatomy. The objective of this study was to evaluate the relationships of Burch sutures to surrounding neurovascular anatomic structures in the human cadaver. Methods The retropubic space of 11 unembalmed female cadavers was dissected, and a Burch procedure performed. The distance from the Burch sutures' location through both Cooper's ligament and the vagina to the obturator neurovascular bundle and external iliac vessels was measured. Results The mean distance from the most lateral stitch in Cooper's ligament to the obturator bundle was 25.9 ± 7.6 mm and to the external iliac vessels was 28.9 ± 9.3 mm, and in some instances, these structures were less than 1.5 cm away. Conclusions The obturator bundle and external iliac lie, on average, within 3 cm of sutures placed during a Burch colposuspension. Knowledge of these anatomical relationships is valuable when dissecting the space of Retzius and placing sutures for a Burch to avoid injury.

Minimally invasive procedures for urinary incontinence and pelvic organ prolapse have gained increasing popularity in the past decade. The advantages of minimal access through laparoscopic and vaginal routes include smaller incisions, shortened hospital stay, decreased analgesia, rapid recovery and rapid return to work. The laparoscopic Burch colposuspension and the tension-free vaginal tape procedure were at the forefront of minimal access antiincontinence procedures. The most recent and significant publications regarding laparoscopic Burch colposuspension and tension-free vaginal tape procedure are highlighted in this article.The laparoscopic Burch is time-consuming and requires a steep learning curve in laparoscopic suturing, thwarting its adoption and staying power. The advantages and success of the retropubic midurethral sling procedures such as tension-free vaginal tape have largely replaced all other antiincontinence procedures and have ignited the development and adoption of transobturator midurethral sling procedures and vaginal 'kit' procedures for pelvic organ prolapse.Clinical trials show that laparoscopic Burch cure rates are equal or inferior to tension-free vaginal tape cure rates. Publications regarding laparoscopic Burch colposuspension have tapered significantly in the past year, which may represent the ebb of its utilization. Tension-free vaginal tape and other midurethral sling procedures may become the new 'gold standard' antiincontinence therapy.

OBJECTIVE: To compare the effectiveness of two transperitoneal laparoscopic Burch procedures. METHODS: The sample size required was 30 subjects per group to detect a statistically significant estimated difference of 15% between two surgical procedures with an α = 0.05 and a power of 0.7. Sixty women affected by genuine stress incontinence (GSI) were enrolled and randomly assigned to two groups of 30 women each. All women were treated with the transperitoneal laparoscopic Burch procedure using nonabsorbable sutures (group A) or Prolene mesh (Ethicon, Somerville, NJ) fixed with tacks or staples (group B). The failure rate was defined subjectively and objectively. The subjective evaluation was performed by asking the women to rate their urine loss on a visual analog scale. The objective evaluation was a clinical evaluation using multichannel urodynamic studies. RESULTS: The subjective failure rate was not significantly different between the two groups at 3 months (0% for both groups), 6 months (3.7% versus 3.8% for groups A and B, respectively), and 12 months (7.4% versus 15.4% for groups A and B, respectively) after surgery. At 3 months (3.7% versus 3.8% for groups A and B, respectively) and 6 months (7.4% versus 15.4% for groups A and B, respectively) follow-up, the objective failure rate was not significantly different between the two groups. However, at 12 months after the surgical procedure, the objective failure rate was significantly lower in group A than in group B (11.1% versus 26.9%, respectively; P CONCLUSION: Transperitoneal laparoscopic Burch colposuspension performed using sutures was more effective than the mesh technique.

Objective: Rhythmic contractions of the bladder wall during filling result from the synchronization of bladder wall micromotion and are often observed in the urodynamic tracings of individuals with urinary overactive bladder (OAB). This study’s objective was to develop a novel, non-invasive method to measure bladder wall micromotion and to conduct an initial study to test the hypothesis that elevated micromotion is associated with OAB. Methods: This prospective study enrolled women with OAB and asymptomatic volunteers as measured by the ICIQ-OAB survey. After filling the bladder to 40% cystometric capacity, 85 second cine-loops were obtained using a GE Voluson E8 ultrasound system with an 8 MHz curved, abdominal probe. A custom correlation-based texture tracking MATLAB algorithm was used to measure changes in the bladder wall thickness over time and correlate with changes in vesical pressure. Significant bladder wall micromotion was defined as changes in wall thickness with amplitudes higher than 0.1 mm in the frequency range of 1.75-6 cycles/minute as calculated from Fast Fourier Transform (FFT) analysis. The micromotion algorithm was tested on 30 women including 17 with OAB and 13 asymptomatic volunteers. Results: Micromotion was identified in 41% of subjects with OAB and 0% of asymptomatic volunteers, indicating a significant association of micromotion with OAB (Fisher’s exact test, P=0.010). Micromotion was also found to have a significant association with a clinical diagnosis of detrusor overactivity (Fisher’s exact test, P=0.031). Frequencies with elevated micromotion correlated with frequencies of vesical pressure fluctuations. Conclusions: The feasibility of a non-invasive method to measure bladder wall micromotion was demonstrated using transabdominal anatomical motion mode (M-mode) ultrasound. Presence of micromotion was significantly associated with OAB and with urodynamic-identified rhythm.

The laparotomy Burch has long been considered the gold standard for the repair of genuine stress incontinence. With the advent of laparoscopic Burch, many have argued that possibly this should be the new gold standard. However, when many laparoscopic bladder series were examined, there was some question of whether these should be considered Burch procedures and there is still a lack of long-term laparoscopic data.

OBJECTIVE : To evaluate changes in voiding function before and after Burch colposuspension for genuine stress incontinence. STUDY DESIGN : Full urodynamic evaluations were performed before and three months after surgery on 21 patients undergoing Burch colposuspension for genuine stress incontinence. Sixteen patients underwent the Burch procedure alone, and five underwent an abdominal sacral colpopexy for vaginal vault prolapse in addition to the Burch procedure. The preoperative and postoperative urodynamic studies were compared with each other to see what changes in voiding function had occurred as the result of surgery. RESULTS : Statistical analysis of the differences between the preoperative and postoperative urodynamic studies using blocked analysis of variance showed dramatic decreases in both instrumented and noninstrumented peak and mean urine flow rates and an increase in detrusor pressure at peak urinary flow during voiding. A substantial but not statistically significant increase in mean residual urine was found after surgery in patients who underwent the Burch procedure alone. There were no statistically significant differences in these parameters in patients undergoing the Burch procedure combined with abdominal sacral colpopexy. Using the criteria of a flow rate of 50 cm H 2 O, five patients undergoing the Burch procedure alone had evidence of postoperative outflow obstruction. Three women with complete vaginal vault prolapse had functional outlet obstruction before surgery, and another three women had postoperative outlet obstruction following the combined Burch procedure and sacral colpopexy. CONCLUSIONS : Burch colposuspension produced significant changes in postoperative voiding function three months after surgery, and outflow obstruction induced by surgery appeared to be a significant potential complication. Renewed attention should be devoted to the development of durable but nonobstructive operations for the surgical cure of genuine stress incontinence.

Many of the benefits of the tension-free vaginal tape procedure for treatment of stress incontinence are derived from its minimally invasive surgical approach. The authors theorized that laparoscopic Burch colposuspensionmight offer the same advantages and conducted this randomized, prospective trial to compare the 2 procedures. Seventy-two women with primary urodynamic stress incontinence requiring surgical correction participated in the study. Thirty-six were randomized to undergo a standard laparoscopic Burch colposuspension, and 36 were randomized to the tension-free vaginal tape (TVT) procedure. Each participant underwent multichannel urodynamic tests at enrollment and one year after surgery. In addition, patients were evaluated with the Urogenital Distress Inventory, Incontinence Impact Questionnaire, pelvic examinations, and patients' voiding diaries at 6 months, 1 year, and 2 years after surgery. Low enrollment and lack of adequate funding led to the decision to stop the trial with a median follow up of 18 months. Thirty-three patients in each study arm were available for analysis. Both groups were similar in clinical and demographic characteristics, except that women who underwent Burch colposuspension were more likely to undergo concomitant lysis of adhesions (32% compared with 11% in the TVT group). Hysterectomy was performed in 25% of patients in each group. The only significant differences in operative data between the two procedures were that total operating room time and length of operation were greater in the Burch colposuspension group (P

A two-page questionnaire was distributed to 304 members of the American Urogynecology Society. Ninety-nine of the 149 respondents reported that they had performed continence surgery on patients who specifically stated their desire for future childbearing. One hundred and eleven recommended the Burch colposuspension, 29 favored the sling procedure, and others advocated different procedures. Urologists as a subset more often recommended either a sling or needle suspension. Twenty-eight percent of respondents felt a trial of labor and vaginal delivery was indicated following incontinence surgery, but 40% stated that they would always perform cesarean section in these patients. A total of 40 vaginal deliveries and 47 cesarean sections were reported. When postpartum continence status was known, only 73% of women who had vaginal deliveries were continent, whereas 95% were continent following cesarean section. Fisher's exact test revealed this to be a statistically significant difference (P = 0.0344).

Objective. The aim of the study was to determine the correlation between genital prolapse and the outcome of the Burch colposuspension. Material and methods. Fifty women with objectively proven recurrent incontinence after Burch colposuspension and 31 women, objectively continent after the colposuspension, were clinically examined with emphasis on genital prolapse. The preoperative vaginal profile of the women was estimated from the patient records. Results. The preoperative vaginal profile demonstrated no significant differences in occurrence of prolapse components between the women who were continent after the colposuspension and those women who had recurrent incontinence. At the follow-up, rectocele and cystocele occurred with significantly higher frequencies among the women with recurrent urinary incontinence than among the women who were continent after the Burch colposuspension (80%, and 46% vs. 42% and 10%; p

Objective To evaluate the 2-year outcome of laparoscopic Burch colposuspension in treating genuine stress incontinence, and to evaluate the prevention of subsequent vaginal vault prolapse by prophylactic apical vault repair. Methods This is a prospective study of 48 consecutive cases diagnosed with genuine stress incontinence and followed for 2 years or longer (range 30 to 41 months) after correction by laparoscopic Burch colposuspension. All patients had a routine urogynecology evaluation, including preoperative and postoperative multichannel urodynamics. Follow-up testing was done at 6 weeks and 1 and 2 years. Result : At 6 weeks, 1 year, and 2 years, the cure rate for genuine stress incontinence was 98, 93, and 89%, respectively. There was a significant decrease in urethral hypermobility and an increase in urethral pressure transmission ratios. Thirty-nine (81%) patients voided spontaneously in less than 24 hours. There was no clinically significant pelvic organ prolapse at 2 years. Conclusion The 2-year cure rate and multichannel urodynamics findings for laparoscopic Burch repair are similar to those reported for laparotomy. Early Result of prophylactic apical vault suspension suggest that the incidence of prolapse observed after routine retropubic urethropexies may be reduced.

Objective To compare the surgical morbidity, postoperative course, and hospital charges of Burch colposuspension performed in conjunction with abdominal versus vaginal hysterectomy. Methods Power analysis indicated that 35 women would be needed in each group to detect a 20% difference in hospital charges between groups with a β error of 20% and an α error of 5%. A computerized records search identified 80 women who underwent Burch colposuspension, 40 of whom underwent concomitant vaginal hysterectomy (vaginal group) and 40 of whom underwent concomitant abdominal hysterectomy (abdominal group). All procedures were performed by one of 16 surgeons at either Good Samaritan Hospital, Cincinnati, Ohio, or the Medical Center of Central Georgia, Macon, Georgia, between 1992 and 1996. Data on demographics, perioperative course, uterine weight, and operative and total hospital charges were obtained for each group. Results There was no statistically significant difference in demographics, surgical history, postoperative hemoglobin and hematocrit decrease, postoperative complications (10 versus 23%), operative charges ($4417 ± 1200 versus $4731 ± 1453), mean uterine weight (113.5 ± 45 versus 125.8 ± 45 g), and operative times (3.0 ± 0.8 versus 2.9 ± 0.7 hours) between the vaginal and abdominal groups, respectively. A post hoc power analysis indicated that each group would require 142 patients to achieve statistical significance for postoperative complication rates. The abdominal group had significantly longer hospital stays (3.1 ± 1.0 versus 2.6 ± 0.7 days) and higher hospital charges ($7337 ± 1828 versus $6342 ± 1123) than the vaginal group. Conclusion When hysterectomy is performed at the time of colposuspension, the vaginal route should be considered seriously when either surgical approach is clinically appropriate.

OBJECTIVE : To compare long-term results of Burch colposuspension and Stamey bladder neck suspension in women with genuine stress incontinence (GSI). STUDY DESIGN : Five hundred three women with GSI underwent Burch colposuspension or a Stamey operation between 1976 and 1992. They were evaluated preoperatively and at least two years after the operations. The preoperative workup consisted of a history, pelvic examination, urine analysis and culture, cotton-tipped swab test, uroflowmetry, cystometry and urethral profilometry. Three hundred eighty-nine of 503 (77.3%) postoperative urodynamic assessments and a one-hour office pad test were performed. A questionnaire was completed by 114 patients who were not able to return to the hospital. The χ 2 and unpaired Student t test were used for statistical analysis. RESULTS : Two hundred thirty-three complications occurred in 503 procedures, and voiding dysfunction had the highest incidence (12.1%). Detrusor instability following antiincontinence operations was detected in 45 of 389 patients (11.5%) who received follow-up urodynamic assessments at least two years postoperatively. In comparison with postoperatively stable bladders, the cystometric and uroflowmetric findings in these 45 patients revealed that the difference in urodynamic evidence of outflow obstruction was statistically significant. The Stamey operation had a statistically significantly higher incidence of postoperative voiding dysfunctions as compared to Burch procedure. CONCLUSION : In this series, detrusor instability following continence procedures might have been the consequence of established postoperative outflow obstruction.

Objective: To compare postoperative course and hospital charges of an open versus laparoscopic approach to Burch colposuspension for the treatment of genuine stress urinary incontinence. Methods: A retrospective chart review was performed to identify all patients undergoing open or laparoscopic Burch colposuspension by the same surgeon over a 2-year period. Patients undergoing additional surgical procedures at the time of colposuspension were excluded from the study. Twenty-one patients underwent open Burch colposuspension and 17 patients underwent laparoscopic colposuspension. Demographic data including age, parity, height, and weight were collected for each group. Both groups also were compared with regard to operative time, operating room charges, estimated blood loss, intraoperative complications, change in postoperative hematocrit, time required to resume normal voiding, length of hospital stay, and total hospital charges. Results: The laparoscopic colposuspension group had significantly longer operative times (110 versus 66 minutes, P < .01) and increased operating room charges ($3479 versus $2138, P < .001). There was no statistical difference in estimated blood loss or change in postoperative hematocrit between the two groups. No major intraoperative complications occurred in either group. Mean length of hospital stay was 1.3 days for the laparoscopic group and 2.1 days for the open group (P < .005). However, total hospital charges for the laparoscopic group were significantly higher ($4960 versus $4079, P < .01). Conclusion: Laparoscopic colposuspension has been described as a minimally invasive, cost-effective technique for the surgical correction of stress urinary incontinence. Although the laparoscopic approach was found to be associated with a reduction in length of hospital stay, it had significantly higher total hospital charges than the traditional open approach because of expenses associated with increased operative time and use of laparoscopic equipment.

Sixty women with urinary incontinence were treated by the Burch colposuspension operation and bladder neck plication. The pre- and postoperative clinical and urodynamic features of the 15 patients with recurrent incontinence were compared and contrasted with 45 women who were cured. Factors which were associated with failed surgery included increaseing age, previous continence surgery, the presence of detrusor instability, and a postoperative rise of intrinsic bladder pressure either on filling of standing up.

Burch colposuspension is a simple retropubic approach for the management of stress incontinence. Major complications are rare but kinking of the ureter can occur in such a procedure, especially in patients who previously have undergone hysterectomy. Careful dissection of the vagina and identification of the ureters are necessary before colposuspension is attempted.