One Expert's Opinion: Burch Colposuspension Still Has Its Place


FORT LAUDERDALE, FLA. — Burch colposuspension isn't the newest or fanciest of the ever-expanding surgical options for treating urinary stress incontinence, but it does have a solid place in the surgical armamentarium for this condition, Matthew Barber, M.D., said at a symposium on pelvic floor disorders sponsored by the Cleveland Clinic Florida.

“In my opinion, Burch colposuspension is the standard by which all other surgeries for genuine stress incontinence should be compared,” said Dr. Barber of the Cleveland Clinic.

Numerous studies over the past decade have upheld the efficacy and safety of this procedure, he noted.

Systematic reviews of the literature in 1996 and 1997, for example, showed that colposuspension is more effective and long lasting than anterior repair or needle suspensions, and is as effective as sling procedures. And a 2001 study of 124 patients with 10- to 15-year follow-up showed a 94% long-term cure rate.

When compared with the traditional bladder neck sling and the use of tension free vaginal tape (TVT), the Burch procedure also compared favorably. In four randomized controlled trials, there was no difference in efficacy between the bladder neck sling and the Burch procedure, although in observational studies, a slightly higher rate of voiding dysfunction was seen with the Burch procedure.

In the largest randomized trial comparing open Burch with TVT, there were no differences in cure rates among 344 patients. Bladder injury was more common with TVT, but voiding and recovery times were longer with Burch, Dr. Barber said.

Disadvantages of the open Burch procedure are the abdominal incision, and—according to at least one study—lower efficacy in patients with intrinsic sphincter deficiency, he said.

The procedure also can be performed laparoscopically, but short-term data suggest this approach is less effective. The outcomes are likely skill dependent, but long-term comparisons are not yet available.

And compared with TVT, the laparoscopic Burch procedure appears to take longer and may not be as effective, at least one study suggests.

Still, the procedure is useful, Dr. Barber said.

“It works, and you shouldn't be ashamed of it,” he added.

The Burch procedure is particularly useful when combined with other laparoscopic or open repairs such as bilateral tubal ligation, hysterectomy, and sacral colpopexy, as well as in younger women who wish to maintain fertility, in women with a history of mesh complications or allergies, and in women who wish to avoid foreign materials, Dr. Barber said.

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