The Burch vesicourethral suspension (BUVS) has long been the procedure of choice for female stress urinary incontinence (SUI) because of its low complication rate and high success rate for all but those patients with type 3 SUI. The pubovaginal sling (PVS) procedure yields a high success rate in those with type 3 SUI but has not gained wide use for all types of SUI, owing to initial reports of a higher complication rate. A retrospective review of early effectiveness and complications associated with BUVS performed on 36 women without type 3 SUI compared to that for PVS performed on 42 women (24 with and 18 without type 3 SUI) at our institution was carried out. To ensure reasonable comparability between groups, homogeneous subsets of 18 women undergoing BUVS and 18 women undergoing PVS were defined. Using conservative criteria for early complications, PVS patients experienced half the complications of BUVS patients with a comparable rate of success.

The bladder neck fascial sling may become a more popular procedure if surgical modifications could ensure more rapid postoperative voiding, yet not compromising the 85% long-term cure rate. In a study of 80 women, we found that increasing the distance from the Prolene knot to the rectus fascia, while simultaneously observing the closure of the bladder neck with a cystoscope, resulted in 92% of women voiding the same day and 93% experiencing no stress incontinence at 1 year.