Objective  To compare the long‐term efficacy of laparoscopic Burch colposuspension with tension‐free vaginal tape (TVT) for the treatment of urodynamic stress urinary incontinence (SUI). Design  Long‐term follow up from a prospective randomised trial. Setting  Academic tertiary referral centre. Sample  Seventy‐two women with urodynamic SUI from two institutions. Methods  Subjects were randomised to either laparoscopic Burch or TVT from August 1999 to August 2002. Follow‐up evaluations occurred 6 months, 1 year, 2 years, and 4–8 years after surgery. Main outcome measures  Subjects completed the Incontinence Severity Index, Urogenital Distress Inventory 6 (UDI‐6), Incontinence Impact Questionnaire (IIQ‐7), and Patient Global Impression of Improvement (PGI‐I) scales. Results  Median follow‐up duration was 65 months (range 12–88 months) with 92% completing at least one follow‐up visit. Seventy‐four percent of subjects had long‐term (4–8 years) follow up. Fifty‐eight percent of subjects receiving laparoscopic Burch compared with 48% of TVT subjects reported any urinary incontinence 4–8 years after surgery (Relative Risk (RR):1.19; 95% CI: 0.71–2.0) with no significant difference between groups. Bothersome SUI symptoms were seen in 11 and 8%, respectively, 4–8 years after surgery (P= 0.26). There was significant improvement in the postoperative UDI‐6 and IIQ‐7 scores in both groups at 1–2 years that were maintained throughout follow up with no significant differences between the groups. Conclusions  TVT has similar long‐term efficacy to laparoscopic Burch for the treatment of SUI. A substantial proportion of subjects have some degree of urinary incontinence 4–8 years after surgery; however, the majority of incontinence is not bothersome.

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