Long term outcomes of Burch colposuspension and transobturator tape and single incision needleless (DynaMesh®- SIS minor) for the surgical treatment of female stress urinary incontinence patients who underwent combined pelvic reconstructive surgery or hysterectomy

Abstract

Background Women with SUI often require combined pelvic reconstructive surgery because of sharing risk factors of pelvic relaxation. The aim of this study was to evaluate the efficacy of Burch colposuspension, the transobturator tape (TOT), and single incision needleless (DynaMesh®- SIS minor) procedures in patients with SUI who also underwent combined pelvic reconstructive surgery or hysterectomy. Methods We carried out a prospective cohort study that included 142 patients who underwent Burch colposuspension (n:43), TOT(n:40), or SIS(n:39) procedures combined pelvic reconstructive surgery or hysterectomy between January 2010 and July 2018. During clinical follow-up, objective cure, subjective cure, failure and surgical success rates were analyzed. Quality of life and symptom severity were assessed by IIQ-7, UDI-6, OAB-V8, SSI, SSQ-8 and PGI-I. Primary outcome was surgical success which was defined when any of the objective cure, subjective cure or improvement has achieved and secondary outcomes were; intraoperative bladder injury, sling extrusion, de novo urgency, voiding dysfunction, length of hospital stay, and outcomes of patient reported quality of life questionnaires. Results Surgical success rate were higher in Burch group than SIS group and also higher in TOT group than SIS group (88,4% vs 61,5% and 87,5% vs 61,5% respectively, p=0,003) Urinary incontinence complaints were higher and quality of life were lower in in SIS group when compared with Burch group. No difference was seen in between Burch and TOT groups, and TOT and SIS groups in terms of IIQ-7, UDI-6, OAB-V8, SSI, and SSQ-8 scores. Conclusions Both Burch and TOT were safe and effective procedures in patients with SUI who required additional pelvic surgeries. Although surgical outcome of SIS procedure in SUI patients that had concomitant pelvic surgeries in our study was not promising, the data are not clear and further randomized studies are needed to clarify these observations.

Burch Procedure: A Historical Perspective

“…Several observational and randomized studies have showed similar eficacy and lower morbidity for MUS procedures compared to Burch colposuspension. 8 9 10 17 Others have cited that there was no statistically significant difference in subjective cure rates, but the objective cure rates tended to be higher for MUS. 19 20 21 22 Even if the definition of objective cure varied widely between available studies, many of them still report that MUSs (retropubic slings or transobturator slings) are superior to Burch colposuspension surgery.…”

“…19 20 21 22 Even if the definition of objective cure varied widely between available studies, many of them still report that MUSs (retropubic slings or transobturator slings) are superior to Burch colposuspension surgery. 10 17 23 24 According to those outcomes, patients receiving midurethral tapes have significantly higher overall and objective cure rates than those receiving Burch colposuspension. In addition, in a survey among professionals, Burch colposuspension would have been chosen only by a minority of surgeons.…”

“…With the advancements in laparoscopic techniques, laparoscopic Burch colposuspension is gaining popularity as a non-mesh alternative, minimally invasive SUI surgery, which is as effective as open surgery. 8 9 10…”