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Objectives: To compare the effectiveness and complications of Burch colposuspension and Mid Urethral Slings (MUS) for the treatment of Stress Urinary Incontinence (SUI). Methods: We conducted a cross-sectional study of 162 patients who underwent surgery for SUI with Burch colposuspension (n=40), tension free vaginal tape (TVT) (n= 59) or transobturator tape (TOT) (n=63), from 2006 to 2014 at the Aga Khan University Hospital- Karachi. All three groups were assessed in terms of demographics, cure rates, intraoperative and postoperative complications at one and five years using incontinence impact questionnaire-short form-7 (IIQ-7) and urogenital distress inventory -short form-6 (UDI-6). Results: Mean age of the participants in Burch, TVT and TOT group was 44.1 ± 7.4, 48.3 ± 8.9, 53.0 ± 9.4 respectively. Majority of patients in TVT group were premenopausal (59.3%) and postmenopausal in TOT group (53.9%). Most abdominal hysterectomies were done in Burch group (40) while vaginal hysterectomies and anterior and posterior colporrhaphy in TOT group (55). All the procedures had both subjective and objective cure rate of more than 82% at one year, with TVT having the highest success rate of 96.61%. The objective cure rate in Burch, TVT and TOT group at five years was 74.19%, 90.30% and 81.25% respectively. Intraoperative complications included hemorrhage in one patient during Burch procedure and bladder perforation in two cases of TVT, with no significant difference in short or long-term complications with either procedure. Conclusions: All the three procedures have equal efficacy and complication rates. Even though TVT is the new gold standard but in view of current debate regarding mesh related complications, there is a need to readdress Burch colposuspension for treatment of SUI. doi: https://doi.org/10.12669/pjms.37.5.4017 How to cite this:Abrar S, Razzak L, Mohsin R. The practice of Burch Colposuspension versus Mid Urethral Slings for the treatment of Stress Urinary Incontinence in developing country. Pak J Med Sci. 2021;37(5):1359-1364. doi: https://doi.org/10.12669/pjms.37.5.4017 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Stress urinary incontinence (SUI) is a highly prevalent health condition that significantly impacts the quality of life. Traditional methods of treatment for SUI, such as pubovaginal sling and Burch colposuspension, have been replaced by the midurethral sling because of its high efficacy, low complication and morbidity rates, and short learning curve. Although multiple behavioral and operative treatments exist, midurethral slings are the gold standard for the treatment of SUI in women. However, several reports have raised concerns about complications caused by the synthetic mesh used in midurethral slings. Therefore, surgical treatment for SUI in women must be chosen with care, taking into account potential complications. Herein, we review the current safety issues pertaining to the use of meshes, the efficacy of traditional surgeries, old and new midurethral slings, and recent data comparing the efficacy and safety of different surgical options. This review is aimed at developing practical guidelines for choosing surgical options for women with SUI.

Women with stress urinary incontinence (SUI) often require combined pelvic reconstructive surgeries because of shared risk factors of pelvic organ prolapse. The purpose of this study was to evaluate efficacies of Burch colposuspension, transobturator tape (TOT), and single-incision needleless (DynaMesh®-SIS minor) procedures in patients with SUI who also underwent combined pelvic reconstructive surgery or hysterectomy. We performed this retrospective cohort study that comprising 122 patients who either underwent Burch colposuspension (n:43), TOT (n:40), or SIS (n:39) procedures along with pelvic reconstructive surgery or hysterectomy between January 2010 and July 2018. During the clinical follow-up, we analyzed cure rates, and surgical success rates of SUI surgery, quality of life, and symptom severity by IIQ-7, UDI-6, SSI, SSQ-8, OAB-V8, and PGI-I scale scores. The primary outcome was surgical success, whereas secondary outcomes included complications and patient-reported outcomes in the quality of life. We found that surgical success rates were higher in Burch group than SIS group and higher in TOT group than in SIS group (88.4% vs 61.5% and 87.5% vs 61.5%, p = 0.003). The quality of life was lower in SIS group than in Burch group. Both Burch and TOT are effective procedures in patients with SUI who require additional pelvic surgeries. Although surgical outcomes of SIS procedure in patients with SUI who underwent concomitant pelvic surgeries in our study were not promising, further studies with SIS are needed to clarify these observations.

Osteitis pubis is a condition which predominantly affects young athletes. However, it may also occur following uro-gynecological interventions. We report a case of osteitis pubis following laparoscopic Burch colposuspension. There are several theories on the pathogenesis of postoperative osteitis pubis and a wide variety of treatment options have shown inconsistent outcomes. In our case, the condition was diagnosed radiologically and was managed with antibiotics and analgesics, which resulted in complete recovery., Highlights • Osteitis pubis is a condition which predominantly affects young athletes. • It may also occur following uro-gynecological interventions. • We report a case of osteitis pubis following laparoscopic Burch colposuspension. • It was diagnosed radiologically and successfully managed with antibiotics and analgesics. • Magnetic resonance imaging is the preferred imaging mode in diagnosing osteitis pubis.

INTRODUCTION: Concerns about vaginal mesh have reduced the use of mid-urethral slings (MUS) in some countries. In view of their potential withdrawal in Belgium and The Netherlands, we polled urogynaecologists on their practice for treating stress urinary incontinence (SUI) and what their experience is with alternative procedures, and we asked them how their patients perceive the risk and success rates. METHODS: A survey among members of the pelvic floor special interest group of the Flemish Society for Obstetrics and Gynaecology, Belgian Association of Urology and Dutch Society of Obstetrics and Gynaecology. RESULTS: Their primary procedure of choice is the MUS (99%). Sixty-five per cent performs at least 25 MUS yearly; they report high success (90%; IQR [85-92]) and low adverse outcome rates. Physicians anticipate complications as reported in the literature: 5% (IQR [410]) overactive bladder, 5% (IQR [2-10]) voiding problems, 2% (IQR [15]) exposures, 2% (IQR [1-5]) dyspareunia and 1% (IQR [1-3]) chronic pain. Eighty-five per cent of physicians report their patients express fears about having a MUS though usually they cannot precisely tell why. Reportedly they tell their physicians of concerns about pain (54%), exposure (45%), dyspareunia (25%), voiding problems (15%) or overactive bladder (8%). Only half of respondents had ever performed a colposuspension. The majority of these were older and performed colposuspension via laparotomy. Only six (4%) had performed > 20 colposuspensions yearly. CONCLUSION: Dutch and Belgian urogynaecologists estimate success and adverse effect rates of MUS in line with the literature. Their patients most cited worries were fear of chronic pain and exposure. Only half of respondents had ever performed a colposuspension. They were older and performed the procedure via laparotomy.

Background The negative media attention surrounding vaginal mesh procedures has seen a rise in demand for minimally invasive non-mesh options for the treatment of stress urinary incontinence (SUI). The laparoscopic Burch colposuspension (LBC) is a non-mesh alternative to synthetic midurethral slings (MUS) with similar short-term outcomes. However, long-term outcomes are not well established. Aims To evaluate the long-term outcomes of LBC for treatment of SUI in women. Material and methods One hundred and fifty-one cases of LBC were performed by a single surgeon over two private hospital settings between January 2010 and January 2016. Follow-up subjective outcomes were obtained in 137 cases (90.7%) utilising standardised questionnaires. Primary outcome was successful treatment of SUI, defined as subjective cure or significant improvement of stress incontinence symptoms. Secondary outcomes included new-onset or worsened symptoms of overactive bladder (OAB), voiding dysfunction, prolapse, and perioperative complications. Results One hundred and thirty-seven patients were analysed with a mean follow-up of 50.6 months (range: 13-89 months). Primary outcome of successful treatment was achieved in 90.5% of women. New-onset or worsened symptoms of OAB was reported in 10.2%, with a further 8.8% of women experiencing symptomatic voiding dysfunction. Sixteen patients (11.7%) reported new-onset or worsening symptoms of prolapse. There were no major surgical complications. Conclusions LBC is a safe and effective long-term treatment for SUI, with low failure rates and minimal adverse outcomes. It is a suitable alternative for women with contraindications to mesh or those having concomitant laparoscopic procedures.

This chapter summarizes the results of the Stress Incontinence Surgical Treatment Efficacy (SISTEr) trial, which randomized women with stress urinary incontinence to an autologous sling procedure versus a Burch colposuspension. Overall treatment success favored the fascial sling over the Burch procedure group, as did the stress incontinence–specific success rate at 24 months. Postoperative voiding dysfunction and urge incontinence were more common in the sling group than the Burch group. These findings supported the historical shift toward slings (autologous and synthetic) versus Burch colposuspension procedures in clinical practice.

Patients with preoperative stress incontinence symptoms or occult stress urinary incontinence have a lower risk to undergo subsequent antiincontinence operations after vaginal prolapse interventions with concomitant midurethral sling insertion than those patients with prolapse surgery only. However, serious adverse events occur more frequently in patients after vaginal prolapse operations with midurethral slings but not after sacrocolpopexy with additional Burch colposuspension.

Purpose To describe our approach to an underutilized technique, the robotic Burch Colposuspension Introduction In 2019, the FDA recalled the use of transvaginal mesh for pelvic organ prolapse procedures (Center for Devices and Radiological Health, 2019) [ 1 ]. Following this announcement, the use of urethral slings also fell out of favor while procedures such as autologous fascial sling and colposuspensions became more popular as women and practitioners alike were seeking alternative SUI treatment options. The mid urethral sling (MUS) is currently the gold standard for the management of stress urinary incontinence. The MUS is both safer and more effective than a Burch Colposuspension (Fusco et al., 2017) [2] . For those that do not desire mesh, or have failed a prior procedure, the Burch Colposuspension remains a useful procedure (Viet-Rubin et al., 2019) [3] . The Robotic Burch is a minimally invasive, quick, and easy to perform procedure. Disadvantages of Burch Colposuspension may include cost, increased operative time, and potential lack of availability in ambulatory settings. Materials and methods The Da Vinci Xi system is utilized with a 3 or 4 port configuration. An 8 mm camera trocar is placed in the umbilicus. An 8 mm trocar is placed 8 cm laterally on each side of the camera port. In a 4 port configuration, the #4 8 mm trocar is placed 8 cm laterally to the #3 arm. If an assistant port is desired, this can be placed 8 cm laterally to the #1 arm, at least 2 cm above the anterior superior iliac spine (ASIS). A Fenestrated Bipolar Forceps is utilized in the #1 arm. A Monopolar Scissors is utilized in the #3 arm. A Prograsp Forceps is utilized in the #4 arm in a 4 port configuration. The patient is placed in a steep Trendelenburg position. Results A successful robotic colposuspension with a duration of less than 60 min total operation is performed. Conclusion The Robotic Burch Colposuspension is a minimally invasive procedure to manage stress urinary incontinence in those that do not desire a MUS, or have failed it. The Robotic Burch is a quick, easy, and minimally invasive approach to manage SUI.

Background There are few adequately powered long-term trials comparing midurethral sling and Burch colposuspension. Recent concerns about synthetic mesh with new stringent clinical and research governance support the need for evidence to facilitate shared decision making. Objective This study aimed to compare long-term outcomes of open Burch colposuspension with the retropubic midurethral sling. Study Design A matched cohort study of 1344 women with urodynamic stress incontinence (without intrinsic sphincter deficiency) who underwent surgery for stress urinary incontinence. Women had either open Burch colposuspension or the retropubic midurethral sling, from January 2000 to June 2018, in a tertiary center. Follow-up was by chart review and one-time phone follow-up until 2019, using a dedicated database. Primary outcomes were the presence or absence of stress urinary incontinence on follow-up, the success of index surgery based on response to validated questionnaires of patient-reported outcomes, and retreatment rates. Secondary outcomes are described below. Matching (1:3) was done at baseline to avoid confounding. Results The study included 1344 women who had either Burch colposuspension (336) or retropubic midurethral sling (1008). Mean follow-up was 13.1 years for Burch colposuspension and 10.1 years for retropubic midurethral sling. In the Burch colposuspension group, 83.0% of patients (279 of 336) reported no ongoing stress urinary incontinence at the time of the latest follow-up vs 85.0% (857 of 1008) in the retropubic midurethral sling group (P=.38). Success in terms of the latest reported International Consultation on Incontinence Questionnaire—Urinary Incontinence Short Form (defined as International Consultation on Incontinence Questionnaire—Urinary Incontinence Short Form score of ≤6) where these data were available were similar within both groups: 76.0% (158 of 208 where this was available) in Burch colposuspension vs 72.1% (437 of 606 where this was available) in retropubic midurethral sling (P=.32). Where this information was available, success defined by a Patient Global Impression of Improvement of “very much improved” and “much improved” was similar between Burch colposuspension and retropubic midurethral sling groups (84.1% [243 of 289] vs 82.0% [651 of 794]; P=.88). Where data were available, 88.1% of women (178 of 202) in the Burch colposuspension group said they were very likely to recommend the surgery to family or a friend vs 85.0% (580 of 682) in retropubic midurethral sling (P=.30).Overall, 3.6% needed repeat incontinence procedures (13 in Burch colposuspension group [3.8%] vs 35 in retropubic midurethral sling group [3.5%]; P=.73). The incidence of mesh exposure was 1.0 %. Notably, 1 Burch colposuspension patient had a suture in the bladder during follow-up; 5 patients have reported long-standing pain across the study population. Overall, 51 women reported new-onset overactive bladder symptoms on follow-up: 10 of 336 (3.0%) had Burch colposuspension and 41 of 1008 (4.1%) had retropubic midurethral sling (P=.41). The need for future prolapse surgery per index procedure was 3.3% after Burch colposuspension vs 1.1% postretropubic midurethral sling (P=.01). Moreover, 9 of the 11 patients who needed a prolapse repair after Burch colposuspension required a posterior repair. The incidence of long-term severe voiding difficulty needing self-catheterization was similar in both groups (0.3% in Burch colposuspension and 0.5 % in retropubic midurethral sling group; P=1.00). Conclusion This study shows no difference in success, patient satisfaction, or complications between Burch colposuspension and retropubic midurethral sling, although the risk of posterior compartment prolapse operations after Burch colposuspension is increased. Reoperation rates for incontinence were similar in both groups. Chronic pain was a rare outcome.

Stress urinary incontinence (SUI) is a common type of urinary incontinence adversely affecting the quality of life of women. For mild SUI, life style changes, pelvic floor exercises and medical treatment with duloxetine may help. Most patients of moderate to severe SUI usually require surgical treatment. Various surgical treatment options include Kelly's plication, Burch colposuspension, bulking agents and sling surgeries. Although, suburethral fascial slings including the autologous rectus fascia slings were in vogue before 1990, they were overtaken by minimally invasive, faster and easier artificial midurethral slings (tension free vaginal tape and transobturator tape). However, observation of serious long-term and life changing complications of synthetic midurethral slings like mesh erosion, chronic pelvic pain and dyspareunia led to their adverse publicity and medico legal implications for the operating surgeons. This led US FDA (Food and Drug Administration) to issue a warning against their use. Currently, their use has significantly decreased in many countries, and they are no longer available in some countries. This has led to renaissance of use of natural autologous fascial sling, especially rectus fascia for surgical management of SUI. Although performing rectus fascia sling surgery is technically more challenging, takes longer, has more short-term morbidity like voiding dysfunction, their long-term success is high with very little risk of serious complications like mesh erosion, chronic pelvic pain and dyspareunia. However, multicentric trials and longer follow ups are needed before it's routine recommendation This review discusses the role of autologous fascial sling (especially rectus fascia) for the surgical management of SUI in the current time and the need of ongoing training of this procedure to gynecology residents and urogynecology fellows.

Background: Anti-incontinence suspension procedures in women include Burch colposuspension or needle suspension procedures. Even though bladder injury is a known complication of any needle urethral or colposuspension procedure in women, it is rare. Delayed presentation may occur with lower urinary tract symptoms or hematuria. However, synechiae formations in bladder have rarely been reported. In this study, we report two cases presenting late with synechiae formation inside the bladder as a result of the suspension suture actually passing through the bladder and thus sewing the posterior and anterior walls of bladder together. Case Presentation: Two ladies presented late after Burch colposuspension with nonresolving urinary symptoms. Both these ladies demonstrated a "smiley bladder sign" caused by a filling defect on cystogram. Cystoscopy revealed a synechial pillar attaching the anterior and the posterior walls, reminiscent of stalagnate-like column in the bladder cavity in both cases. Both cases were managed endoscopically with laser incision avoiding injury to the ureteral orifices. Conclusion: A rare previously undescribed complication of Burch colposuspension and its typical appearance on cystogram is reported along with its endoscopic management. These cases highlight the use of intraoperative cystoscopy to prevent such complications.

Mid-urethral sling procedures (MUS) have been the surgical option of choice for most gynaecologists and urologists treating stress urinary incontinence (SUI) in women around the world for almost 20 years, since their introduction in the late 1990s. The evidence suggests that the long-term effectiveness of the MUS is good and similar to the Burch Colposuspension and the fascial pubovaginal slings. The bulking agents are now being put forward as another minimally invasive option for the surgical treatment of SUI. Despite the increasing evidence that the retropubic MUS are more effective in long term and in high failure risk women with recurrent SUI and ISD, the TOT continues to have a high satisfaction and usage worldwide.

We aimed to present an overview of recent data on the proven surgical techniques for female stress urinary incontinence (SUI) including their efficacy, safety, and adverse events. Surgical treatment of female SUI is the mainstay of urogynecological surgery, with two accepted gold standard techniques: Burch colposuspension and synthetic midurethral slings (MUS). Thorough understanding of the historical evolution of the surgical techniques before and after the introduction of integral theory is important. This theory enhances our comprehension for the continence mechanism of MUS, which are currently the level 1, grade A, recommended anti-incontinence procedures in all recent guidelines. However, in cases with specific contraindications, mesh surgery should be avoided. Burch colposuspension and autologous rectus fascia pubovaginal sling (RF PVS) procedures are the recommended surgical techniques with level 1 evidence in such cases and should be performed after a complete evaluation. Urethral bulking agents and artificial sphincters are the other options for severe and complicated cases. Because each surgical intervention for female SUI has inherent advantages and risks of complications, selection of the optimal surgical technique should be based on the risk-benefit ratio for every patient. Comprehension of recent data derived from systematic meta-analyses and latest guidelines and knowledge of the safety, long-term efficacy, and possible adverse events of all currently accepted surgical techniques for female SUI provide an insight to properly counsel women and to select the optimal individualized anti-incontinence surgery.

Context\ud Retropubic (RP-TVT) and transobturator miurethral (TO-TVT) midurethral sling (MUS) are popular surgical treatments for female stress urinary incontinence. The long-term efficacy and safety of the procedures is still a topic of intense clinical research and several randomised controlled trials (RCTs) have been published in the last years\ud \ud Objective\ud To evaluate the efficacy and safety of MUS compared with other surgical treatments for female stress urinary incontinence.\ud \ud Evidence acquisition\ud A systematic review and meta-analysis of the literature was performed using the Medline, Scopus, and Web of Science databases to update our previously published analyses.\ud \ud Evidence synthesis\ud Twenty-eight RCTs were identified. In total, the meta-analyses included 15 855 patients. Patients receiving MUS had significantly higher overall (odds ratio [OR]: 0.59, p = 0.0003) and objective (OR: 0.51, p = 0.001) cure rates than those receiving Burch colposuspension. Patients undergoing MUS and pubovaginal slings had similar cure rates. Patients treated with RT-TVT had higher subjective (OR: 0.83, p = 0.03) and objective (OR: 0.82, p = 0.01) cure rates than those receiving TO-TVT. However, the latter had a lower risk of intraoperative bladder or vaginal perforation (OR: 2.4, p = 0.0002), pelvic haematoma (OR: 2.61, p = 0.002), urinary tract infections (OR: 1.31, p = 0.04) and voiding lower urinary tract symptoms (OR: 1.66, p = 0.002). Sensitivity analyses limited to RCTs with follow-up durations >60 mo demonstrated similar outcomes for RP-TVT and TO-TVT. No significant differences in efficacy were identified comparing inside-to-out and outside-to-in TO-TVT but vaginal perforations were less common with the former (OR: 0.21, p = 0.0002).\ud \ud Conclusions\ud The present analysis confirms the superiority of MUS over Burch colposuspension. The studies comparing insertion of RT-TVT and TO-TVT showed higher subjective and objective cure rates for the RP-TVT but at the cost of higher risks of some complications and voiding lower urinary tract symptoms. Efficacy of inside-out and outside-in techniques of TO-TVT insertion was similar, although the risk of vaginal perforation was lower in the inside-to-out TO-TVT.\ud \ud Patient summary\ud Retropubic and transobturator midurethral slings are a popular treatment for female stress urinary incontinence. The available literature suggest that those slings are either more effective or safer than other older surgical procedures. Retropubic tapes are followed with slightly higher continence rates as compared with the transobturator tapes but are associated with higher risk of intra- and postoperative complications.

An 86-year-old lady was referred for a 3-cm bladder stone 28 years after Burch colposuspension. Cystoscopy showed a stone over a nonabsorbable suture, eroding from the right anterolateral bladder wall. The patient underwent a transurethral holmium laser lithotripsy and thulium laser removal of the eroded bladder wall. A high index of suspicion of suture erosion should always be present in case of de novo symptoms in women who underwent colposuspension, even in the long-term period.

Objectives Stress urinary incontinence (SUI) surgery and hysterectomy are often performed in the same session. The aim of this study was to determine which urinary incontinence surgery would be a better option for patients who would undergo a hysterectomy for various indications. Study design This retrospective study included 65 patients who had undergone total laparoscopic hysterectomy and anti-incontinence surgery (TOT or Burch).A retrospective chart review was performed to record the patient data including demographic features, duration of operations, postoperative complete blood count values and post-void residual urine volumes. ICIQ-UI and UDI-6 interrogations related to urinary incontinence were compared pre- and postoperatively between two groups. Results There was no difference in demographic characteristics and menopausal status between groups. No significant difference was found between two groups in postoperative period for urinary incontinence scores (p>0,05). When the duration of operation was compared, the duration was significantly higher in the TOT group. And the hematocrit drop in the group with TOT was significantly higher (p Conclusions Because the success rates of Burch colposuspension and transobturator procedures are similar, either of these two methods can be selected according to patient characteristics and surgeon experience. But Burch colposuspension seems to be more preferable in terms of blood loss and operation time than TOT.

Stress urinary incontinence (SUI) has a reported prevalence between 12.8% and 46%. There is no doubt that SUI has been shown to negatively impact the everyday quality of life (QOL) of women who suffer from this dysfunction. The economic burden for the treatment of urinary incontinence has been estimated to be approximately 19 billion annually in the United States. Risk factors for the development of SUI include age, obesity, previous pelvic surgery, and childbirth. Surgical management of SUI is the standard of care once conservative options, such as behavioral modification, pelvic floor exercises, fluids modification, and scheduled voiding, have been exhausted. The surgical options have evolved over the last few decades to include the Burch colposuspension, periurethral bulking agents, pubovaginal slings, and the newest multitude of approaches for midurethral synthetic slings. The synthetic slings include retropubic, transobturator, and the newest additions which include the so-called single-incision slings. The aims of this chapter include the evaluation and management of SUI and review each of the surgical techniques currently available to pelvic floor surgeons.

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...

Background: Stress urinary incontinence (SUI) affects ∼30% of all women; 4% need surgery; and SUI is most often seen in women ages 25–50. There are >200 surgical treatment methods. Burch colposuspension (BC) and sling operations are used widely today. Objective: Short-term results of robotic-assisted and abdominal approaches were evaluated in patients who had hysterectomies with BC. Materials and Methods: This cross-sectional study involved 40 patients with SUI and benign gynecologic conditions. The patients received either robotic-assisted hysterectomy with BC (Surgery A; 20 patients) or abdominal hysterectomy and BC (Surgery B; 20 patients). All patients were assessed at the Gulhane Military Medical Academy, in Etlik, Ankara, Turkey. The patients' demographics; intraoperative findings; complications; preoperative and postoperative 6th month Urinary Distress Inventory short form (UDI-6), urinary Incontinence Impact Questionnaire short form (IIQ-7) scores; and postoperative 6th month continence s...

Aims To review available evidence regarding evaluation and treatment of stress urinary incontinence (SUI) and provide recommendations for management of urinary incontinence under specific conditions determined by the International Federation of Gynecology and Obstetrics (FIGO) Working Group. Methods The FIGO Working Group discussed the management of SUI during meetings and assessed the evidence. The search of evidence was performed using MEDLINE® and Cochrane databases as well as additional searches from societies and major organizations for additional guidelines and recommendations and hand searches from bibliographies. Initial searches from 1985 to December 31, 2012 extended until July 15, 2015. After review, recommendations are made based on levels of evidence according to the recommendations from Oxford EBM Center. Results Initial evaluation of SUI consists of history and physical examination; cough stress test, evaluation for urinary tract infections (UTI), assessment of urethral mobility, and post-void residual volumes (LOE 5). Urodynamic studies are not necessary to evaluate patients with uncomplicated SUI (LOE 1a). Conservative treatment should be tried prior to surgery and more importantly in areas of low resources (LOE 5). Midurethral slings (MUS), pubovaginal (traditional suburethral) slings (PVS), and Burch colposuspension are effective in treating SUI (LOE 1a). Patients with SUI with ISD or UUI appear to have lower cure rates than patients without (LOE 2-4). There are limited data on surgical outcomes under limited resources (LOE 5). Conclusions MUS, PVS, and Burch colposuspension are effective treatments for SUI. Evidence for recommendations to treat patients in underserved low resource areas is lacking. Neurourol. Urodynam. © 2016 Wiley Periodicals, Inc.

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.

Objectives Since 1999, we have performed implantations of Remeex ® adjustable prosthetics as rescue treatment for complex or persistent stress urinary incontinence (SUI) after failure of other surgical treatments (Burch colposuspension, Marshall-Marchetti-Krantz (MMK) or tension-free transvaginal tape [TVT] until 2003 and transobturator tape [TOT] since 2003). We present the results of our series, which include cases with severe complications. Material and method Retrospective study of women diagnosed with complex or refractory SUI who underwent Remeex ® implantation between October 1999 and December 2013. In 5 cases, we conducted cystocele correction in the same operation as the placement of the Remeex ® . Results Sixty women, with a mean age of 66.87 years (range 39–85), underwent operations. The procedure was successful in 68.33% of the cases. The failures consisted of the following: 10% of the women had mixed urinary incontinence (UI) with multiple bladder diverticula; 8.33% had mild SUI; and 13.33% had urgency urination without UI. Thirty-five percent required adjustments. We recorded 3 cases with severe complications: disabling severe UI in a patient who underwent multiple operations, massive pelvic hemorrhage in a patient undergoing standard antiplatelet therapy and infected vaginal calculi measuring 7 cm on an extruding Remeex thread in a paraplegic patient 4 years after the implantation. Conclusions Remeex ® is an effective and safe procedure for achieving continence in cases of complex or refractory SUI, although it is not exempt from severe complications. Following rigorous protocols can help detect complications and treat them in a timely manner.

Introduction To evaluate the quality of economic analysis (EA) of surgical procedures for stress urinary incontinence (SUI) in women. Methods A MEDLINE search on EA for SUI surgical procedures for the years 2000–2014 included the MeSH terms “tension-free vaginal tape,” “TVT,” “trans-obturator tape,” “TOT,” “Burch colposuspension” (BC), “stress urinary incontinence,” “economic analysis,” and “cost-effectiveness analysis.” Important criteria for evaluating articles were selected from panels that set out criteria to evaluate EA [Scales CD, Jr., Christopher SS, American Urological Association 32:121–128, 2013], [Hsieh MH, Maxwell MV, J Urol 178 1867–1874, 2007], [Wu JM, Catherine CM, Conover MM, et al., Obstet Gynecol 123 1201–1206, 2014]. Results Thirteen articles were identified: TVT compared to BC (6), to other surgical procedures for SUI (1), to TOT (3) and to the mini-sling (1); open BC compared to laparoscopic BC (1), and analysis of various slings and meshes for various types of incontinence (1). Articles originated from: United States (3), Europe (4), United Kingdom (4), and Canada (2). Eight described cost-effectiveness analysis (CEA), two cost-utility analysis, and three cost comparison. Follow-up time for patients ranged from 6 to 24 months in eight articles, with four having a minimum of 24 months follow-up. Studies mostly adhered to the criteria, however indirect costs, sensitivity analysis, and efficacy parameters varied. Long-term synthetic sling-related complications were not included. Conclusion Although CEA for SUI surgery is a burgeoning field, study comparisons remain difficult due to some variability, including health care delivery systems. As women live longer, long-term data will become critical as complications and reoperations can affect the real cost of SUI corrective procedures. Neurourol. Urodynam. 9999:XX–XX, 2015. © 2015 Wiley Periodicals, Inc.

To compare the efficacy and complications of laparoscopic and conventional approach for Burch colposuspension in treatment of stress urinary incontinence. Study design: Prospective randomised trial. Methods :After standered history and preoperative evaluation, groupA( n=30) offered open Burch colposuspension and group B (n =30) had laparoscopic colposuspension. Results: No significant differences regarding objective and subjective outcome of total 60 patients follow up at 1,6 and 12 months. More operative time found in group B (92±5.2min)versus group A(58.2±4.4min),P ˂0.001 . Laparoscopic approach was less in pain (P ˂0.001)and hospital stay(P ˂0.001) .No significant differences between both groups regarding intraoperative and post operative complications . Conclusion: Although laparoscopic burch offers an alternative to conventional burch with shorter hospital stay, less postoperative pain and quicker recovery, but still it has its drawbacks. It needs long learning curve and has prolonged operative time

Implantation of a synthetic midurethral sling (SMUS) is the most commonly performed anti-incontinence operation in women worldwide. The effectiveness of the SMUS is comparable to that of the historical gold standards--autologous fascial slings and the Burch colposuspension. Much controversy, however, has evolved regarding the safety of this type of sling. Overall, the quality of the studies with respect to assessing risks of SMUS-associated complications is currently poor. The most common risks in patients with SMUS include urethral obstruction requiring surgery (2.3% of patients with SMUS), vaginal, bladder and/or urethral erosion requiring surgery (1.8%) and refractory chronic pain (4.1%); these data likely represent the minimum risks. In addition, the failure rate of SMUS implantation surgery is probably at least 5% in patients with stress urinary incontinence (SUI). Furthermore, at least one-third of patients undergoing sling excision surgery develop recurrent SUI. Considering the additional risks of refractory overactive bladder, fistulas and bowel perforations, among others, the overall risk of a negative outcome after SMUS implantation surgery is ≥15%.

Stress urinary incontinence is not a deadly disease, but for the large population of women suffering from it, it is a very important issue. Especially in the continuously aging population all over the world, there is more and more need for treatment of this serious medical condition. Treatment of female stress urinary incontinence exists already for ages. In the 20th century invasive treatments like Burch colposuspension and pubovaginal slings were the mainstay of surgical treatments. The introduction of the midurethral sling made the procedure less invasive and accessible for more caregivers. Luckily there are many options available and the field is developing quickly. In recent years many new medical devices have been developed, that increase the number of treatment options available and make it possible to find a suitable solution for the individual patient based on subjective and objective results and the chances of complications. This manuscript provides an introduction to the therapeutical options that are available nowadays for female stress urinary incontinence. Keywords: Female, Stress urinary incontinence, Treatment, Urinary incontinence, Pelvic floor muscle training, Suburethral slings

Various surgical techniques are available to treat stress urinary incontinence (SUI). Recent data analysis revealed that both Burch colposuspension and mid-urethral sling (MUS) are valid treatment options. Both the US Food and Drug Administration (FDA) and the Medicines and Healthcare Products Regulatory Agency (MHRA) have reported risks of complications of MUS and it is crucial that pre-operative patients’ counselling should include these. New treatment modalities are also emerging, including bioengineering and nanomaterials; however, these are limited in their current applicability and conventional surgery remains the predominant intervention.

Recently, scarless surgery has become a widely used surgical technique and many laparoscopic surgeons have attempted to reduce incisional morbidity and improve cosmetic outcomes by using fewer and smaller ports. Laparoscopic combined procedures permit simultaneous treatments for multiple pathologies. In single time anaesthesia, these combined minimally invasive procedures gives the advantages of less pain and morbidity, faster recovery and shorter hospital stay. Moreover, these combined procedures can be performed with a single incision and can have additional benefits for the patients and the hospital. Here we describe a single port laparoscopic total hysterectomy and bilateral salpingo-oopherectomy combined with Burch colposuspension. The operation was completed laparoscopically with single port, without intra-operative or postoperative complications, in a single session. The patient was discharged the following morning. With a single incision multidisciplinary laparoscopic approaches can offer suitable, effective and safe treatments.

To compare the effectiveness of transobturator tape (TOT) and Burch colposuspension in the treatment of stress urinary incontinence (SUI).The present retrospective study included 770 patients who underwent SUI surgery with Burch colposuspension (n=498) or TOT (n=272). Clinical follow-up occurred at 2 weeks, 3, 6, and 12 months, and annually thereafter. Objective and subjective cure rates and intra- and postoperative complications were assessed.Among patients who had SUI surgery without another concomitant procedure, the Burch group had a significantly longer mean operation time (41.48 ± 10.61 minutes versus 23.77 ± 10.49 minutes; P0.001) and a significantly longer length of hospital stay (3.11 ± 0.49 days versus 1.98 ± 0.40 days; P0.001), compared with the TOT group. The rates of unintended functional outcomes were lower among women undergoing TOT than among those undergoing the Burch procedure (long-term voiding dysfunction 0.7% versus 4.2%, P=0.007; urinary retention 10.7% versus 26.9%, P0.001). The 5-year cure rates were similar in the 2 groups (objective cure rate, 73.9% versus 77.5%, P=0.574; subjective cure rate, 76.8% versus 81.7%, P=0.416).In terms of efficacy, TOT appears equal to Burch colposuspension; however, TOT has fewer unintended functional outcomes than Burch colposuspension.

Objective To compare the cost-effectiveness (CE) of tension-free vaginal tape (TVT) with that of burch colposuspension (BC) for the treatment of female stress urinary incontinence (SUI). Materials and Methods A Markov-chain decision model was created to simulate treatment of SUI with TVT or BC using Treeage Pro 2011 software (Treeage Software Inc., Williamstown, MA, USA). Costing data were obtained from the Medicare Resource-Based Relative Value Scale. Data regarding the success of TVT vs BC were obtained from the peer-reviewed literature, as were corresponding utilities for different continence states. The CE of each procedure was calculated and compared, and sensitivity analyses were performed. Results At 10-year follow-up, TVT was more cost-effective (CE = $1495/quality-adjusted life year [QALY]) than BC (CE = $1824/QALY). Sensitivity analysis showed that TVT was more cost-effective than BC if the cost of the TVT device was

Surgical management continues to be the mainstay of treatment for patients with moderate to severe stress urinary incontinence who are nonresponsive to conservative measurements. In the past, the Burch colposuspension was considered the first line of treatment; however, since the introduction of mid-urethral slings in the mid 1990s the retropubic sling has become the “gold standard.” Tension-free vaginal tape (TVT) is the original retropubic procedure with good long-term efficacy and safety data available. However, in an attempt to decrease the risk of retropubic complications, such as vascular, bowel, or bladder injury, the transobturator and single incision mini-slings have been described. In this review, we give an overview on the recent data available on conventional anti-incontinence procedures as well as other more recently developed procedures. Recent studies with more than 10 years of follow-up continue to confirm the effectiveness of the TVT sling in the long-term, which the other approaches need to match.

To compare medical costs of three surgical procedures for the treatment of primary stress urinary incontinence: the laparoscopic Burch colposuspension procedure, the laparoscopic two-team sling procedure, and the transobturator tape (TOT) procedure.We performed a retrospective observational study of isolated minimally invasive surgical procedures (no concomitant surgery) in 18 women with primary stress incontinence. Six women underwent a laparoscopic Burch colposuspension procedure, six underwent a laparoscopic two-team sling, and six underwent a TOT procedure. The main outcome measure was the mean aggregated medical cost per patient treated. Itemized calculations were made for (1) equipment costs; (2) surgeon, surgical assistant, and anaesthesiologist reimbursements; (3) nursing costs; (4) operating and recovery room costs; and (5) costs of stay in hospital.The mean cost per patient undergoing a TOT procedure was $2547 (95% CI $2260 to $2833); for a laparoscopic Burch colposuspension it was $4354 (95% CI $3465 to $5244); and for a laparoscopic two-team sling procedure it was $5393 (95% CI $4959 to $5826). Significant differences were found across procedures using a one-way ANOVA. A TOT was lower in cost than both a Burch procedure, with a mean cost difference of $1807.88 (P0.001), and a sling procedure, with a mean cost difference of $2834.73 (P0.001).A transobturator tape procedure has less direct medical costs than a laparoscopic Burch colposuspension or a laparoscopic two-team sling procedure in the surgical treatment of stress urinary incontinence.

Background Subjective and objective cure rates after primary surgery for female stress urinary incontinence are good. Still, some women will undergo repeated operations for incontinence. Objective To study the reoperation rate after incontinence surgery and to compare the reoperation rates between different surgery types. Design, setting, and participants This national register-based study included all Finnish women who had surgery for stress urinary incontinence during a 23-yr study period (1987–2009), both in inpatient and outpatient hospital settings. Subcohorts for follow-up times of 5-yr and 10-yr were evaluated separately. Outcome measurements and statistical analysis Primary operations, reoperation rate, patient age, time until reoperation. Results and limitations A total of 38 500 women had surgery for stress urinary incontinence from 1987 to 2009. Two thousand and seventy-six women (7.2%) had a reoperation with a rate of 7.8/1000 woman-yr. The reoperation rate was 8.3/1000 women-yr after a Burch colposuspension and 4.8/1000 after a retropubic midurethral sling. In the 10-yr follow-up, reoperation was more common after a Burch compared with a retropubic midurethral sling (odds ratio: 1.6, 95% confidence interval: 1.3–1.9). There was no difference in the reoperation rate between retropubic and transobturator midurethral slings in the 5-yr follow-up. Conclusions Reoperation rate is lower after midurethral slings compared with Burch colposuspension. Patient summary Mesh slings are surgically effective treatments for stress urinary incontinence. There are fewer reoperations after implanting these slings compared with older methods that do not use synthetic material. Different mesh slings have equally good results.

Long term results of LSCP (13 years of follow up) performed with the described double mesh technique are rather good according to satisfaction index and QoL questionnaires. But 25% of patients had to be re operated average 5–8 years after first procedure, mainly for recurrent cystocele. This means that the results published in most series with a follow up between 1 and 3 years are truly overoptimistic.

The debate is still open. The series are not easily comparable and there’s no well led randomized trial comparing results with or without combined sling in all groups of patients undergoing LSCP. Our advice is to insert a sling concomitantly in patients with symptomatic or occult SUI.

Background. Synthetic mid-urethral mesh slings are the most common primary surgical treatment for stress urinary incontinence (SUI) and have been designated as the standard of care by the American Urogynecologic Society. In recent years, synthetic mesh has come under increased scrutiny by the Federal Drug Administration (FDA) due to concerns over patient safety. This has led to more surgeons and patients preferring Burch colposuspension to treat SUI. Case. We discuss two cases of suture erosion into the urethra and bladder. They presented with irritative voiding symptoms and recurrent urinary tract infections. Both were discovered years after a Burch colposuspension. Conclusion. As reported in the literature as early as 1999, erosion is a complication associated with many types of incontinence surgery and not unique to mesh based sling operations. Burch colposuspension should not be favored solely to avoid erosion and patients should be counseled accordingly. Teaching Point. Cystourethroscopy performed intraoperatively or postoperatively is essential for early diagnosis and treatment of complications related to incontinence surgery.

The retropubic tension-free vaginal tape (TVT) procedure replaced Burch colposuspension as the primary surgical method for stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) in women in our department in 1998. In this study we compared the short-term and long-term clinical outcomes of these surgical procedures. Using a case series design, we compared the last 5 years of the Burch procedure (n = 127, 1994–1999) with the first 5 years of the retropubic TVT procedure (n = 180, 1998–2002). Information from the medical records was transferred to a case report form comprising data on perioperative and long-term complications as well as recurrence of UI, defined as bothersome UI or UI in need of repeat surgery. Other endpoints were rates of perioperative and late complications and the rates of prolapse surgery after primary surgery. The data were analyzed with the chi-squared and t tests and survival analysis using SPSS. The cumulative recurrence rate of SUI in women with preoperative SUI was significantly higher after the Burch procedure, but no difference was observed in women with MUI. There were no significant differences in rates of perioperative and late complications. At 12 years there was a significant increase in rates of repeat surgery for incontinence and prolapse in women after the Burch procedure. The long-term efficacy of TVT surgery was superior to that of Burch colposuspension in women with SUI. In addition, the rate of late prolapse surgery was significantly higher after the Burch procedure.