Burch Retropubic Urethropexy Compared With Midurethral Sling With Concurrent Sacrocolpopexy

Abstract

Objective To compare efficacy and safety of retropubic Burch urethropexy and midurethral sling in women with SUI undergoing concomitant pelvic floor repair with sacrocolpopexy. Methods Women were randomly assigned to Burch retropubic urethropexy (n=56) or retropubic midurethral sling (n=57) through dynamic allocation balancing age, body mass index, history of prior incontinence surgery, intrinsic sphincter deficiency, preoperative incontinence diagnosis, and prolapse stage. Overall and stress-specific continence primary outcomes were ascertained with validated questionnaires and blinded cough stress test. Results Enrollment was June 1, 2009, through August 31, 2013. At 6 months, no difference was found in overall (29 midurethral sling [51%] vs 23 Burch [41%]; P=.30) (odds ratio [OR] [95% CI], 1.49 [0.71–3.13]) or stress-specific continence rates (42 midurethral sling [74%] vs 32 Burch [57%]; P=.06) (OR [95% CI], 2.10 [0.95–4.64]) between groups. However, the midurethral sling group reported greater satisfaction (78% vs 57%; P=.04) and were more likely to report successful surgery for SUI (71% vs 50%; P=.04), and to resolve preexisting urgency incontinence (72% vs 41%; P=.03). No difference was found in patient global impression of severity or symptom improvement, complication rates, or mesh exposures. Conclusion There was no difference in overall or stress-specific continence rates between midurethral sling and Burch urethropexy groups at 6 months. However, the midurethral sling group reported better patient-centered secondary outcomes.

Complications after minimally invasive sacrocolpopexy with and without concomitant incontinence surgery: A National Surgical Quality Improvement Program (NSQIP) database study

“…One survey found that most providers primarily prefer to perform MUS for SUI over Burch procedures, fascial slings and other incontinence procedures . Providers may be persuaded to choose MUS preferentially given emerging evidence that urgency symptoms may be lower following MUS than Burch at the time SCP . Some authors have hypothesized that this may be due to the opposing vaginal vectors of Burch (which pulls the bladder neck anteriorly) and SCP (which pulls the vagina more posteriorly toward the levator muscles) affecting urethral coaptation and/or alter detrusor function …”

“…Many care providers are offering non‐invasive MUS for occult stress incontinence at the time of SCP. One trial randomized 113 women undergoing abdominal SCP to Burch procedure or MUS and found better patient‐centered secondary outcomes in the MUS group including higher satisfaction rates and higher proportions of women describing the procedure as successful . There was no difference in stress‐specific continence rates or complication rates between the two groups.…”

<p>Revisiting current treatment options for stress urinary incontinence and pelvic organ prolapse: a contemporary literature review</p>

“…However, women undergoing laparoscopic Burch suspensions had a significantly longer operating time and hospital stay. Although Burch urethropexy is traditionally performed with open sacrocolpopexies (SCP) to treat SUI, recent evidence suggests that it may be inferior to the MUS in continence rates at both 1 and 2-year post sacrocolpopexy (SCP) 31,47. This is possibly due to a lack of surgeon expertise in Burch urethropexy performance worldwide, compared to surgeon comfort in performing the MUS 48…”

Two-Year Results of Burch Compared With Midurethral Sling With Sacrocolpopexy

“…We previously conducted a randomized superiority trial comparing these anti-incontinence procedures during abdominal sacrocolpopexy (5). Although women undergoing midurethral sling reported greater satisfaction (78% vs 57%; P =.04), no difference was found in overall (midurethral sling vs Burch, 51% vs 41%; P =.30) and stress-specific continence (midurethral sling vs Burch, 74% vs 57%; P =.06) between the 2 treatment groups at 6-month follow-up (5).…”