Burch Procedure: A Historical Perspective / Procedimento de Burch: Uma perspectiva histórica

Abstract Introduction The Burch procedure (1961) was considered the gold standard treatment for stress urinary incontinence (SUI) before the midurethral slings (MUSs) were introduced, in 2001. Objective This historical perspective of the Burch's timeline can encourage urogynecological surgeons to master the Burch technique as one of the options for surgical treatment of SUI. Search Strategy and Selection Criteria A bibliographic search was performed in the PubMed and National Library of Medicine (NIH) databases with the terms Burch colposuspension AND history AND stress urinary incontinence in the last 20 years. The original article by Burch (1961) was included. The references were read by three authors. The exclusion criterion was studies in non-English languages. Biomedical Library Special Collections were included as historical relevant search. Data Collection, Analysis and Main Results Some modifications of the technique have been made since the Burch procedure was first described. The interest in this technique has been increasing due to the negative publicity associated with vaginal synthetic mesh products. Twenty-nine relevant articles were included in the present review article, and numerous trials have compared Burch colposuspension with MUS. Conclusion This historical perspective enables the scientific community to review a standardized technique for SUI. Burch colposuspension should be considered an appropriate surgical treatment for women with SUI, and an option in urogynecological training programs worldwide.

Resumo Introdução O procedimento de Burch (1961) foi considerado o tratamento padrão ouro para a incontinência urinária de esforço (IUE) antes da introdução dos slings de uretra média (SUMs), em 2001. Objetivo Esta perspectiva histórica da linha do tempo do procedimento de Burch pode encorajar os cirurgiões uroginecológicos a dominar a técnica deste procedimento como uma das opções para o tratamento cirúrgico da IUE. Estratégia de busca e critérios de seleção A busca bibliográfica foi realizada nas bases de dados PubMed e National Library of Medicine (NIH) com os termos Burch colposuspension AND history AND stress urinary incontinence nos últimos 20 anos. O artigo original de Burch (1961) foi incluído. As referências foram analisadas por três autores com exclusão de estudos em idiomas diferentes do inglês. Coleções de bibliotecas biomédicas foram incluídas por ordem de relevância histórica. Coleta de dados, análise e principais resultados Algumas modificações de técnica foram realizadas desde que o procedimento de Burch foi inicialmente descrito. O interesse por essa técnica vem aumentando devido à publicidade negativa associada aos produtos de tela sintética vaginal. Vinte e nove artigos relevantes foramincluídos, e vários estudos compararam a colposuspensão de Burch com SUMs. Conclusão Essa perspectiva histórica possibilita à comunidade científica revisar uma técnica padronizada para a IUE. A colposuspensão de Burch pode ser considerada um tratamento cirúrgico adequado paramulheres com IUE, e uma opção emprogramas de treinamento uroginecológico em todo o mundo.

Caracterización de pacientes con antecedente de colposuspensión de Burch que consultan en uroginecología / Characterization of patients with a background of Burch colposuspension consulting in urogynecology

INTRODUCCIÓN Y OBJETIVOS: La incontinencia de orina de esfuerzo (IOE) es una patología muy frecuente. El tratamiento estándar corresponde al uso de cintas medio uretrales. Dentro de las técnicas quirúrgicas clásicas se encuentra la colposuspensión de Burch (CSB), poco frecuente en la actualidad. El objetivo de este estudio es describir las características de las pacientes con antecedentes de una CSB que consultan en la unidad de Uroginecología. MÉTODOS: Revisión tipo transversal de los datos ingresados a la unidad de Uroginecología del Hospital Dr. Sótero Del Río desde 2007 al 2019. Análisis descriptivo de los antecedentes de las pacientes con antecedente de CSB. RESULTADOS: Durante el periodo analizado, 63 pacientes presentaban antecedentes de CSB. La edad promedio fue 68 años, 88% eran post menopáusicas, 60% fueron sometidas a histerectomía y 24% a cirugías por prolapso (POP). La paridad promedio fue 3 hijos, 15% tuvieron al menos un parto por fórceps. Un 51% consultó por IOE, 54% por vejiga hiperactiva (VH) y 56% por sensación de bulto o peso. El 38% consultó por incontinencia de orina mixta, 37% por IOE + POP y 41% por VH + POP. 22% fueron reoperadas, 16% por medio de TVT y 6% por TOT. CONCLUSIONES: El antecedente de CSB es infrecuente en nuestra población. Similar a lo descrito en la literatura, más de un 50% de las pacientes consultó por síntomas de recurrencia y por complicaciones como POP y VH. Próximos estudios deberían evaluar si el antecedente de CSB es un factor de riesgo de complicaciones quirúrgicas o recurrencia.

INTRODUCTION AND OBJECTIVES: Stress urinary incontinence (SUI) is a common pathology. The standard treatment corresponds to the mid urethral slings. Among the classic surgical techniques is Burch colposuspension (CSB), currently rare. The objective of this study is to describe the characteristics of the patients with a previous history of CSB who consult in the Urogynecology unit. METHODS: Cross sectional review of the data of all the patients admitted to the Urogynecology unit of the Dr. Sótero Del Río Hospital from 2007 to 2019. Descriptive analysis of the antecedents of the patients with a history of CSB. RESULTS: During the analyzed period, 63 patients had a history of CSB. The average age was 68 years. 88% were postmenopausal, 60% underwent hysterectomy, and 24% underwent prolapse (POP) surgery. The average parity was 3, 15% had at least one forceps delivery. 51% consulted for SUI, 54% for overactive bladder (OAB) and 56% for sensation of lump or weight. 38% consulted for mixed urine incontinence, 37% for SUI + POP and 41% for OAB + POP. 22% were reoperated, 16% through TVT and 6% through TOT. CONCLUSION: The history of CSB is infrequent in our population. Similar to that described in the literature, more than 50% of the patients consulted for recurrence symptoms and complications such as POP and OAB. Future studies should assess whether a history of CSB is a risk factor for surgical complications or recurrence.

Surgical treatment for stress urinary incontinence in women: A systematic review and meta-analysis / Tratamento cirúrgico da incontinência urinária de esforço em mulheres: revisão sistemática e metanálise

Abstract Objective To compare surgical treatments for stress urinary incontinence in terms of efficiency and complications. Data Sources We searched the MEDLINE and COCHRANE databases using the terms stress urinary incontinence, surgical treatment for stress urinary incontinence and sling. Selection of Studies Forty-eight studies were selected, which amounted to a total of 6,881 patients with scores equal to or higher than 3 in the Jadad scale. Data Collection Each study was read by one of the authors, added to a standardized table and checked by a second author. We extracted data on intervention details, follow-up time, the results of treatment and adverse events. Data Synthesis Comparing retropubic versus transobturator slings, the former was superior for both objective (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.05-1.54) and subjective (OR, 1.23; 95% CI, 1.02-1.48) cures. Between minislings versus other slings, there was a difference favoring other slings for subjective cure (OR, 0.58; 95% CI, 0.39- 0.86). Between pubovaginal sling versus Burch surgery, there was a difference for both objective (OR, 2.04; 95% CI, 1.50-2.77) and subjective (OR, 1.64; 95% CI, 1.10-2.44) cures, favoring pubovaginal sling. Therewas no difference in the groups: midurethral slings versus Burch, pubovaginal sling versus midurethral slings, transobturator slings, minislings versus other slings (objective cure). Retropubic and pubovaginal slings are more retentionist. Retropubic slings have more bladder perforation, and transobturator slings, more leg and groin pain, neurological lesion and vaginal perforation. Conclusion Pubovaginal slings are superior to Burch colposuspension surgery but exhibit more retention. Retropubic slings are superior to transobturator slings, with more adverse events. Other slings are superior to minislings in the subjective aspect. There was no difference in the comparisons between midurethral slings versus Burch colposuspension surgery, pubovaginal versus midurethral slings, and inside-out versus outside-in transobturator slings.

Resumo Objetivo comparar tratamentos cirúrgicos para incontinência urinária de esforço (IUE), quanto à eficiência e complicações, por meio de revisão sistemática seguida de metanálise. Fonte dos dados Fizemos busca nas bases de dados MEDLINE e COCHRANE, utilizando os termos stress urinary incontinence, surgical treatment for stress urinary incontinence e sling. Seleção dos estudos Selecionamos 48 estudos, totalizando 6.881 pacientes com pontuação igual ou maior do que 3 na escala de Jadad. Coleta de dados Cada estudo foi lido por um autor, colocado em tabela, e checado por outro autor. Extraímos dados como detalhes das intervenções, tempo de seguimento, resultados do tratamento e eventos adversos. Síntese dos dados Não houve diferença nas comparações: sling de uretra média versus cirurgia de Burch, quanto às curas objetiva (razão de chances [RC]: 1,29; intervalo de confiança de 95% [IC95%]: 0,76-2,20) e subjetiva (RC: 1,16; IC95%: 0,67- 2,00); sling de uretramédia transobturatório outside-in versus inside-out quanto às curas objetiva (RC: 0,78; IC95%: 0,45-1,35) e subjetiva (RC: 0,83; IC95%: 0,58-1,18); sling pubovaginal e de uretra média quanto à cura objetiva (RC: 1,64; IC 95%: 0,52-5,15). Comparando sling retropúbico comtransobturatório, o retropúbico foi superior quanto às curas objetiva (RC: 1,27; IC95%: 1,05-1,54) e subjetiva (RC: 1,23; IC95%: 1,02-1,48). Entre minislings e outros slings, houve diferença favorável a outros slings quanto à cura subjetiva (RC: 0,58; IC95%: 0,39-0,86) mas não quanto à cura objetiva (RC: 0,72; IC95%: 0,47-1,10). No grupo sling pubovaginal e Burch, houve diferença quanto à cura objetiva (RC: 2,04; IC95%: 1,50-2,77) e subjetiva (RC: 1,64; IC95%: 1,10-2,44). Slings de uretra média apresentam mais erosão, enquanto a cirurgia de Burch tem mais complicações na ferida operatória e infecção do trato urinário. Slings retropúbicos e pubovaginais sãomais retencionistas. Slings retropúbicos estãomais associados a lesão vascular, hematomas e perfuração vesical, e transobturatórios, à dor na perna e virilha, lesão neurológica e perfuração vaginal. Conclusão Slings pubovaginais são superiores à cirurgia de Burch, porém mais retencionistas. Slings retropúbicos são superiores aos transobturatórios, embora tenham mais eventos adversos. Outros slings são superiores aos minislings em relação ao aspecto subjetivo. Não houve diferença nas comparações entre slings de uretra média e cirurgia de Burch, slings pubovaginais, transobturatórios inside-out e inside-in.

Evaluación de los resultados de la cura de incontinencia urinaria por técnica de Burch y cabestrillos suburetrales sin tensión

Objetivo: Evaluar los resultados positivos y negativos de la cirugía de incontinencia urinaria (IU) por técnica de colposuspensión de Burch y cabestrillos suburetrales sin tensión, tanto transobturatriz y tension-free vaginal tape, independientemente de las distintas mallas y tipos de agujas existentes en el mercado. Métodos: Se realizó un estudio no experimental, documental, retrospectivo, correlacional y longitudinal. La población estuvo constituida por la totalidad de pacientes con diagnóstico de incontinencia urinaria de esfuerzo, que acudieron a la consulta externa de cirugía General, Urología y Uroginecología del Hospital Dr. José Ignacio Baldó, entre enero 2002 y abril 2012. La muestra estuvo representada sólo por las pacientes que fueron sometidas a cura operatoria de IU por técnica de Burch o cabestrillos suburetrales sin tensión. Resultados: La proporción estimada de evoluciones satisfactorias con el uso de la técnica colposuspensión Burch fue de 87,9 % y con el uso de cabestrillos suburetrales sin tensión fue 97,3 %. La proporción de complicaciones transoperatorias en el caso de la técnica colposuspensión Burch alcanzó la cifra de 3,0 % y en el caso de cabestrillos suburetrales sin tensión fue de 10,8 %. La proporción de complicaciones postoperatorias en el caso de la técnica colposuspensión Burch alcanzó 33,3 % y en el caso de cabestrillos suburetrales sin tensión fue de 37,8 %. Conclusiones: No se encontraron diferencias estadísticamente significativas entre ambas técnicas quirúrgicas evaluadas en relación a proporción de evoluciones satisfactorias, complicaciones transoperatorias y postoperatorias.

Objective: To assess the positive and negative outcomes of both transobturator (TOT) and tension-free vaginal tape (TVT), regardless of the different meshes and existing types of needles on the market. Methods: A non-experimental, documentary, retrospective, correlational and longitudinal study was performed. The population was constituted by all patients diagnosed with stress urinary incontinence (SUI), who attended at General Surgery, Urology and Urogynaecology Service of the hospital Dr. Jose Ignacio Baldo, between January 2002 and April 2012. The sample was represented only by patients who underwent surgical cure of UI by Burch technique or tension-free suburethral slings. Results: The estimated proportion of satisfactory developments with the use of the Burch colposuspension technique was of 87.9% and with the use of tension-free suburethral slings was of 97,3%. The transoperative complications in Burch colposuspension technique was 3, 0 % and in tension-free suburethral slings was of 10.8%. The postoperative complications in the case of Burch colposuspension technique reached 33.3% and in the case of tension-free suburethral slings was 37.8%. Conclusions: No statistically significant differences were found between the two surgical techniques evaluated in relation to proportion of successful developments, transoperative and postoperative complications.

Cistouretropexia laparoscópica tipo Burch para el tratamiento de la incontinencia urinaria de esfuerzos: seguimiento a largo plazo / Laparoscopic Burch colposuspension for the treatment of stress urinary incontinence

Objetivos: Conocer las complicaciones, las tasas de cura subjetiva y valoración con el índice de severidad de Sandvik a largo plazo de pacientes en quienes se realizó cistouretropexia laparoscópica tipo Burch para la corrección de su incontinencia urinaria de esfuerzo (IUE). Método: Análisis descriptivo, retrospectivo. Nivel de evidencia III. Se incluyeron las pacientes con diagnóstico de IUE tipo Blaivas IIB, a quienes se les practicó Burch laparoscópico en la Clínica del Prado y Profamilia Medellín, entre los años 2003 y 2007. Las variables principales a evaluar fueron edad, tiempo quirúrgico, cura subjetiva, índice de severidad de Sandvik y complicaciones. Resultados: Se analizaron 72 pacientes con promedio de edad de 46,57 +/- 9,54 años. El tiempo promedio de seguimiento fue de 24,4 meses (rango: 9,0-55,8 meses). El tiempo quirúrgico promedio fue de 79,83 minutos (rango: 44-160 minutos). Refirieron cura subjetiva 56 pacientes (77,8 por ciento). El índice de severidad de Sandvik muestra que a largo plazo 56,9 por ciento pacientes estaban secas con remisión completa de los síntomas y el 13,8 por ciento pacientes tenían pérdidas leves. Conclusiones: El Burch laparoscópico es una opción efectiva para el manejo de la incontinencia urinaria de esfuerzo tipo Blaivas IIB. Provee tasas de curación subjetiva a largo plazo similares a otros tipos de tratamiento. Es una opción más a tener en cuenta en el manejo de la IUE, en especial aquellas pacientes con patologías asociadas que se beneficien del abordaje por laparoscopia.

Objectives: To describe the subjective cure rate, the score of the Sandvik test and the complications after laparoscopic Burch in patients with stress urinary incontinence (SUI). Methods: Prospective descriptive study. We included all patients diagnosed with SUI Blaivas type IIB, and operated on by laparoscopy in two reference institutions between 2003 and 2007. Results: We analyzed 72 patients with an average age of 46.57 +/- 9.54 years. The average follow-up was 24.4 months, with a minimum of 9 and a maximum of 55.8. The average operating time in 29 patients in which we only performed laparoscopic Burch with or without colporrhaphy was 93.7 minutes (55-180 minutes); 56 patients (77.8 percent) reported subjective cure. The Sandvik's severity index found 56.9 percent dry patients and 13.8 percent with mild losses. Conclusion: The laparoscopic management may be useful in some patients, especially those who will be carried to laparoscopy by some other indication. Subjective cure rates are similar to other types of surgery.

Ultrassonografia uretrovesical como método eficaz de avaliação dos parâmetros prognósticos de tratamento cirúrgico da incontinência urinária de esforço / Urethrovesical ultrasonography as an effective method for evaluating prognostic parameters in the surgical management of stress urinary incontinence

OBJETIVO: Comparar parâmetros ultrassonográficos relacionados à junção uretrovesical e uretra proximal em pacientes curadas e não curadas, tratadas cirurgicamente pela técnica de Burch, com a finalidade de estabelecer se há correspondência com fatores prognósticos. MATERIAIS E MÉTODOS: Trinta pacientes foram selecionadas e divididas em dois grupos: 15 consideradas clinicamente curadas e 15 consideradas não curadas. As pacientes foram submetidas a ultrassonografia transvulvar no pré-operatório e aos 30 e 180 dias do pós-operatório. RESULTADOS: No pré-operatório, o deslocamento da uretra proximal foi maior nas pacientes curadas (15,87 ± 4,55 mm × 12,47 ± 3,52 mm - p < 0,05). No pós-operatório, no esforço, a distância vertical da junção uretrovesical e a uretra proximal foram maiores nas pacientes curadas (12,87 ± 5,80 mm × 5,13 ± 6,55 mm - p < 0,01; e 13,07 ± 6,44 mm × 6,20 ± 6,14 mm - p < 0,01), e o deslocamento vertical da junção uretrovesical e da uretra proximal foi maior nas pacientes não curadas (8,47 ± 3,98 mm × 5,13 ± 2,36 mm - p < 0,001; e 8,33 ± 4,54 mm × 5,20 ± 2,90 mm - p < 0,05). CONCLUSÃO: A ultrassonografia da junção uretrovesical e da uretra proximal pode ser considerada como um método eficaz de avaliação dos parâmetros prognósticos do tratamento cirúrgico de mulheres com incontinência urinária de esforço.

OBJECTIVE: To compare sonographic parameters related to the urethrovesical junction and proximal urethra in cured and not cured patients surgically treated with the Burch technique, for establishing a possible correlation with prognostic factors. MATERIALS AND METHODS: Thirty female patients were selected and divided into two groups: 15 patients considered as clinically cured and 15 not cured. The patients were submitted to preoperative transvulvar ultrasonography, with the examination being repeated at the 30th and 180th postoperative days. RESULTS: At the preoperative examination, the proximal urethra displacement was largest in the cured patients (15.87 ± 4.55 mm × 12.47 ± 3.52 mm - p < 0.05). At the postoperative examination, with strain, the vertical distance of the urethrovesical junction and the proximal urethra were largest in the cured patients (12.87 ± 5.80 mm × 5.13 ± 6.55 mm - p < 0.01; and 13.07 ± 6.44 mm × 6.20 ± 6.14 mm - p < 0.01), and the vertical displacement of the urethrovesical junction and proximal urethra was largest in the not cured patients (8.47 ± 3.98 mm × 5.13 ± 2.36 mm - p < 0.001; and 8.33 ± 4.54 mm × 5.20 ± 2.90 mm - p < 0.05). CONCLUSION: Ultrasonography of the urethrovesical junction and proximal urethra can be considered as an effective method for evaluating prognostic parameters in the surgical management of women with stress urinary incontinence.

An unusual foreign body in the bladder 5 years after a laparoscopic burch colposuspension / 대한산부인과학회지

Stress urinary incontinence is the predominant symptom in young and middle-aged women. Stress urinary incontinence is not a life-threatening disease but can lead to discomfort, which can also limit the social and sexual activities of women. Lately TOT operation is performed in most cases of stress urinary incontinence. But Burch colposuspension had been one of successful operations for genuine stress incontinence until TOT procedure was performed. Burch colposuspension has significant morbidity such as bleeding, infection and wound hematoma, and subsequent complications including voiding difficulty, de novo detrusor instability, recurrent urinary tract infection and uterovaginal prolapse. In this case, Delayed migration of the suture and bolster after an endoscopic Burch colposuspension across tissue planes, with subsequent erosion into the bladder, is uncommon. We report an unusual complication 5 years after Burch operation. It was an intravesical foreign body granuloma caused by suture material.

Resultados del Tension Free Vaginal tape (TVT) en el manejo quirúrgico de las recidivas post cirugía de Burch / The results of tension free vaginal tape after Burch's technique failure

La técnica de Burch es una de las que muestra mejores resultados a largo plazo en el tratamiento de la Incontinencia Urinaria de Esfuerzo (IOE), sin embargo también presenta recidivas. El principio básico de la uretropexia de Burch es subir el cuello vesical a una posición intrabdominal retropúbica. Si este principio no funciona deben considerarse soluciones quirúrgicas basadas en otros principios fisiopatológicos para una segunda cirugía, como es el TVT. Nuestro objetivo es evaluar los resultados del TVT en pacientes recidivadas después de cirugía de Burch, para ello realizamos una revisión retrospectiva de estas pacientes que fueron operadas por segunda vez con técnica de TVT. De 129 pacientes sometidas a TVT en nuestro Servicio, 17 presentaban el antecedente de recidiva de IOE después de cirugía de Burch. El promedio de edad fue de 56,3 años. El TVT se realizó en promedio 7,75 (3 - 13) años después del Burch. El 100 por ciento de las pacientes se mantiene sin IOE después de 49,7 (2 - 84) meses de seguimiento. No tenemos pacientes con perforación vesical ni retención de orina. En 4 (23,5 por ciento) se desarrolló urgencia de Novo. Una paciente presentó erosión que cerró espontáneamente. El TVT ha demostrado en nuestras pacientes ser una excelente alternativa para tratar las recidivas del Burch, pudiendo explicarse ya que la uretra media donde debe colocarse la malla es un área quirúrgicamente virgen y porque los mecanismos para evitar la pérdida de orina son distintos en las dos técnicas.

In most published series Burch colpocystourethropexy suggest an objective success rate for primarysurgery of between 80 percent and 90 percent. The aim of our study is to evaluate TVT as treatment after Burch failure. We evaluated retrospectively 129 TVT procedures at our institution between August 2000 and August 2007. We identified 17 patients who underwent a TVT procedure for recurrent stress urinary incontinence after Burch surgery. The mean age of the patient was 56.3 years. Mean follow-up was49.7 months (range 2 to 84). TVT was performed in average 7.75 years (range 3 to13) after Burch surgery. All the patients were considered cured. Our series didn’t have immediate complications defined as bladder or bowel perforation or postoperative urinary retention. We had one patient (5.9 percent) with vaginal erosion treated successfully with supportive measures. De novo urgency occurred in 23,4 percent(4 patients). According to our data, TVT shows good outcome in the treatment of Burch failure. TVT is a safe, effective, and minimally invasive option. We believe that clinical success is achieved because the mesh is in a different area from Burch colpocystourethropexy and different continence mechanismsare involved.

Laparoscopic Burch Colposuspension with the Choi's Hook / 대한산부인과학회지

OBJECTIVE: Burch operation has been effective method for the treatment of stress incontinence. Burch operation is a well-accepted procedure for treating stress urinary incontinence secondary to urethral hypermobility without intrinsic sphincter deficiency and is the reference standard with which other procedures are compared. This study is to evaluate the effectiveness of the Choi's hook in laparoscopic Burch operation. METHODS: This study included 47 patients who had undergone laparoscopic Burch operation from October 2000 through March 2005. Of these 47 patients, 27 patients underwent traditional laparoscopic Burch operation (Group 1) and 20 patients underwent laparoscopic Burch operation with Choi's Hook on anchoring the endopelvic fascia to the Cooper's ligament (Group 2). RESULTS: The mean age of patients of Group 1 was 55.6+/-9.37 years of age and that of Group 2 was 56.0+/-5.93 years of age. There is no difference in the mean age of patients (P>0.05). The mean operating time was 90.5+/-15.32 minutes for Group 1 and 38.5+/-10.14 minute for Group 2. The mean operating time was shorter in Group 2 than Group 1 (P0.05). CONCLUSION: We performed laparoscopic Burch operation with the Choi's Hook on anchoring the endopelvic fascia to the Cooper's ligament. When we compared traditional laparoscopic Burch operation with laparoscopic Burch operation with Choi's Hook, we could shorten the operation time using the Choi's Hook.

Comparison of Outcomes between Burch Colposuspension with and without Concomitant Abdominal Hysterectomy

A total abdominal hysterectomy may cause a postoperative vesicourethral dysfunction due to an injury to the pelvic nerves. However, many incontinent women with benign diseases of the uterus and its adnexae have undergone a Burch colposuspension with a concomitant abdominal hysterectomy. This study was undertaken to compare the outcomes of a Burch colposuspension performed alone with that of a Burch with a concomitant abdominal hysterectomy. This study included 132 women, who, were treated for primary urinary incontinence from February 1999 to February 2002 and were diagnosed with stress urinary incontinence by means of the urodynamic test at the Department of Obstetrics and Gynecology at Yonsei University Hospital. Forty-two women underwent a Burch colposuspension alone (Burch group) and 90 women underwent a Burch colposuspension with a concomitant abdominal hysterectomy (hysterectomy group). Between the Burch and hysterectomy groups, the mean age, parity, menopausal rate, Hormone Replacement Therapy (HRT) rate, 1 year follow-up outcomes and postoperative complications were compared using the subjective and objective stress tests according to the retrospective chart review. The mean age (54.6 +/- 0.5 vs 58.6 +/- 9.2 years, p=0.382), parity (3.3 +/- 1.2 vs 3.6 +/- 1.7), menopausal rate (71.4 vs 77.7%), or HRT rate (23.3 vs 11.2%) of the two groups were similar. Complications related to surgery were encountered in 5 patients (11.9%) in the Burch group and in 7 patients (7.8%) in the hysterectomy group (p=0.842). One year follow-up subjective symptoms were encounterd in 2 patients in the Burch group and in 4 patients in the hysterectomy group (p=1.00). The stress test was positive in only one patient in the hysterectomy (p=1.00). No significant difference was observed in the 1 year follow-up outcomes, which were 91.4% (32/35 patients) in the Burch and 91.2% (73/80) in the hysterectomy groups. The results showed that there were no adverse effects on the 1 year follow-up outcomes or complications in patients who underwent a Burch colposuspension with an abdominal hysterectomy.

Comparative Study of Tension-free Vaginal Tape and Burch Colposuspension in the Surgical Management of Female Stress Urinary Incontinence / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare the effectiveness, easiness, postoperative complications between tension-free vaginal tape (TVT) and Burch colposuspension (BC) in the surgical management of female genuine stress urinary incontinence. METHODS: A retrospective study of 77 cases with stress urinary incontinence at Department of Obstetrics and Gynecology and Urology, Pochon CHA University Medical College from January 2000 to December 2002, followed up more than 6 months. All of 77 cases were above grade 2 genuine stress urinary incontinence, 37 cases were performed tension-free vaginal tape, 40 cases were performed Burch colposuspension. RESULTS: Cure rate was 91.4% in the tension-free vaginal tape (TVT) group, 90% in the Burch colposuspension group. The mean operative time for TVT was 23.4 minutes and for Burch colposuspension was 47.2 minutes. The mean hospital stay in TVT was 1.8 days and in Burch colposuspension was 5.2 days. The incidence and severity of postoperative complication is similar in both groups. CONCLUSION: The cure rates of TVT were comparable with Burch colposuspension in the surgical management of female genuine stress urinary incontinence. And the incidence and severity of postoperative complication is similar in both groups. Moreover TVT is simple procedure more than Burch colposuspension.

Comparative Study of Tension-free Vaginal Tape and Burch Colposuspension in the Surgical Management of Female Stress Urinary Incontinence / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare the effectiveness, easiness, postoperative complications between tension-free vaginal tape (TVT) and Burch colposuspension (BC) in the surgical management of female genuine stress urinary incontinence. METHODS: A retrospective study of 77 cases with stress urinary incontinence at Department of Obstetrics and Gynecology and Urology, Pochon CHA University Medical College from January 2000 to December 2002, followed up more than 6 months. All of 77 cases were above grade 2 genuine stress urinary incontinence, 37 cases were performed tension-free vaginal tape, 40 cases were performed Burch colposuspension. RESULTS: Cure rate was 91.4% in the tension-free vaginal tape (TVT) group, 90% in the Burch colposuspension group. The mean operative time for TVT was 23.4 minutes and for Burch colposuspension was 47.2 minutes. The mean hospital stay in TVT was 1.8 days and in Burch colposuspension was 5.2 days. The incidence and severity of postoperative complication is similar in both groups. CONCLUSION: The cure rates of TVT were comparable with Burch colposuspension in the surgical management of female genuine stress urinary incontinence. And the incidence and severity of postoperative complication is similar in both groups. Moreover TVT is simple procedure more than Burch colposuspension.

Comparison of Burch Colposuspension, Pubovaginal Sling Operation and Tension-Free Vaginal Tape for Surgical Treatment of Stress Urinary Incontinence In Women / 대한산부인과학회잡지

OBJECTIVE: The object of this study was to compare the cure rate and confirm the clinical efficacy of three most frequent surgical procedures for stress urinary incontinence (Burch colposuspension, pubovaginal sling operation, tension-free vaginal tape). MATERIALS AND METHODS: We collected datas from the records of ninety-one patients who were diagnosed as stress urinary incontinence from Jan. 1999 to May 2001. Burch colposuspension was performed by department of gynecology, Severance hospital in thirty-three patients, pubovaginal sling operation was performed by department of urology in twenty-eight patients, and tension-free vaginal tape was performed by department of urology in thirty-one patients. We investigated the characteristics of patients, preoperative urodynamic study results, cure rates and complication rates for the result, and compared them by x2-test. RESULTS: There were statistically no significant differences between the cure rate of each operation after 3, 6 month of operation but after 12 months of follow up, the cure rate of pubovaginal sling operation was significantly higher than that of Burch operation and tension-free vaginal tape. CONCLUSION: The cure rate of pubovaginal sling operation was significantly higher after 12 months of follow up after surgery. There was no significant difference between cure rates of Burch operation and tension- free vaginal tape. We propose randomized prospective study with larger population in the future.

Comparison between Extraperitoneal Laparoscopic Burch Colposuspension Using Mesh and Tacker and Open Burch Procedure / 대한비뇨기과학회지

PURPOSE: A Laparoscopic Burch colposuspension has rapidly become one of the primary surgical treatment options for genuine stress urinary incontinence (GSI). An extraperitoneal laparoscopic Burch procedure using polypropylene mesh and Tacker was compared with a open Burch procedure to evaluate the efficacy of this procedure. MATERIALS AND METHODS: A retrospective study of 61 consecutive cases diagnosed with GSI, and a subsequent followed up for 24 months or even longer (range: 24-40 months) were conducted. These evaluations were compared with 28 open Burch procedures during the same time period. All patients were assessed for their previous medical history, physical examination, cough stress test, transperineal ultrasonography, urethrocystoscopy, filling cystometries and urethral pressure profiles at both rest and strain. RESULTS: The overall success rate of the two methods was similar. The results showed that an extraperitoneal laparoscopic Burch operation reduced the duration of catheter drainage (1.4+/-0.8 days versus 3.6+/-1.2 days), hospital stay (2.2+/-1.1 days versus 7.8+/-1.5 days), and operation time (48.2+/-18.4min. versus 57.4+/-20.2min.) compared to the open Burch operation (p<0.05). However there were no significant differences in the complication rates. CONCLUSIONS: Extraperitoneal laparoscopic Burch colposuspension using a mesh and Tacker provides a durable resolution for GSI with low risk of conversion, short hospitalization, operation time and few complications. Further clinical assessment is necessary to evaluate its long-term feasibility.

Osteitis Pubis after Laparoscopic Burch Colposuspension Using Tacker(R) / 대한비뇨기과학회지

Osteitis pubis is a noninfectious, painful, inflammmatory condition affecting the periosteum, cartilage, and ligaments of the symphysis pubis. It has been associated with urologic and gynecologic procedures, pregnancy and rheumatologic disorders. Despite seven decades of speculation, its pathogenesis, diagnostic criteria, natural history and optimal therapy for osteitis pubis remain controversial. We had experienced two cases of osteitis pubis after laparoscopic Burch colposuspension using prolene mesh and Tacker(R). All cases of osteitis pubis were treated with conservative managements.

Long Term Follow-up Results of Extraperitoneal Laparoscopic Burch Bladder Neck Suspension / 대한비뇨기과학회지

PURPOSE: Despite the encouraging short-term results after the laparoscopic Burch operation for female stress urinary incontinence, many investigators reported the decreases of the success rate on long-term follow up studies. These facts have urged us to investigate the change of success rate on long term follow up and related factors of them. MATERIALS AND METHODS: This study was performed for 39 patients who have received laparoscopic Burch operation from May 1995 to December 1996. Mean follow up duration was 41 months (32-50 months). Extraperitoneal approach was performed in all cases, and postoperative 3 months and long term follow-up results were assessed using standardized questionnaire and medical record. Symptom grades were categorized by Stamey grade. Factors affecting postoperative outcome and complications were also analyzed. RESULTS: On 3 month short term follow-up, 64.1% were cured and 28.2% were improved. However, on the long term follow-up, success rates were droped to 46.1% and 25.6% respectively. Factors affecting postoperative outcome were preoperative Stamey grade and VLPP. Age, parity, symptom's duration, body weight had no correlation with post-operative results. Of the 12 patients with preoperative symptoms of urgency and/or urge incontinence, 8 patients reported those were disappeared or decreased postoperatively. Obstructive symptoms occurred in 7 cases, but progressively improved with time. CONCLUSIONS: With these results, we could conclude that initial success rate of laparoscopic Burch operation is high, but it declined with time. However, on the basis of the result that Stamey grade I patient had lower failure rate, we could selectively apply this operation for grade I stress urinary incontinence.

Comparison of Extraperitoneal Laparoscopic Versus Open Burch Colposuspension for Treatment of Stress Urinary Incontinence: Long Term Follow-up / 대한비뇨기과학회지

PURPOSE: Laparoscopic Burch colposuspension has been described as an alternative method to the surgical correction of stress urinary incontinence. We attempt to compare long-term results of laparoscopic and open Burch colposuspension in women with stress urinary incontinence. MATERIALS AND METHODS: We retrospectively reviewed 51 consecutive cases of extra peritoneal laparoscopic (n=31) and open Burch colposuspension (n=20). Success rate was assessed by telephone interview and clinical data. RESULTS: Preoperative data of the two groups were not different statistically. The suc cess rate of laparoscopic group was 74.2% with a mean follow-up of 48.1 months and that of open Burch group was 80.0% with a mean follow-up of 43.1 months. On comparing extraperitoneal laparoscopic and open Burch procedure, laparoscopic group significantly required shorter operating time (110 minutes versus 138 minutes; p <0.05), shorter length of hospitalization (3.6 days versus 7.4 days; 0.01) and shorter catheter indwelling time (2.5 days versus 4.2 days; 0.01). CONCLUSIONS: Extraperitoneal laparoscopic Burch colposuspension offers a less in vasive and effective approach to the surgical correction of stress urinary incontinence in terms of success rate, hospital stay and catheter indwelling time in properly selected patients.

Operación de Burch en tratamiento de incontinencia urinaria de esfuerzo / Burch technique in treatment of effort urinary incontinence

La incontinencia urinaria de esfuerzo (IUE) es la más frecuente de las incontinencias urinarias (IU); se define como pérdida involuntaria de orina por aumento de la presión abdominal; están involucrados múltiples factores predisponentes que originan falla de soporte del suelo pélvico; puede o no asociarse a relajación pélvica.Se realizó estudio retrospectivo en el servicio de Ginecología del Hospital Teodoro Maldonado Carbo del IESS; el universo lo constituyó 82 casos (Nov 1994-Abril 2000), cuya edad media fue de 47.8 años; 13 (15.86%) pacientes presentaron colpoperineorrafia previa. La técnica de Burch no presentó complicación operatoria; se retiró sondaje vesical a los 2 días promedio, colocándose nuevamente por retención urinaria, en 15 pacientes; esta es la complicación hospitalaria más frecuente, con esta técnica.Alta médica fue dada a 63 (76.82%) pacientes, 17 (20.74%) no acudieron a ningún control o lo abandonaron y 2 continúan en consulta por recidiva.

Effort urinary incontinence (EUI) is the most frequent variant of the UI. It’s defined as the involuntary loss of urine for elevation of abdominal pressure; multiple predisponent factors are involved.A retrospective study was done at the Gyn Service of Teodoro Maldonado Carbo Hospital.The universe was 82 cases (Nov 94 – Apr 2000); the average age was 47.8 years; 13 patients (15.86%) showed previous colpoperineorraphy.Burch technique didn’t present any amplication; vesical probe was retired in 2 days (average), placing again in 15 patients with incontinence, being this the most frequent hospitalary complication.Discharge was given to 63 patients (76.82%), 17 patients didn’t go to any follow-up and 2 continue the visits for recidivances.

Comparative Evaluation of Abdominal, Transvaginal and Laparoscopic Burch Colposuspension for Genuine Stress Incontinence / 대한비뇨기과학회지

PURPOSE: Burch colposuspension has been used for the treatment of stress urinary incontinence (SUI) with effectiveness. The purpose of this retrospective study was to compare the efficacy among abdominal, transvaginal and laparoscopic Burch colposuspension. We also compared the clinical course and complications after each procedure. MATERIALS AND METHODS: Sixty seven patients underwent Burch colposuspension were evaluated according to their approach methods. All patients were assessed for detailed history, physical examination, urodynamic study, transperineal ultrasonography, operative time, catheter indwelling period, hospital stays, success rate, and complications. RESULTS: The success rates of abdominal, transvaginal and laparoscopic Burch were 90, 86 and 76% respectively, at 26 months follow up. There was no significant complication except for a case of bladder injury in the laparoscopy group. Laparoscopic Burch operation had advantages of less invasive approach, less morbidity, shorter hospital stays and provided successful outcomes in patients with stress urinary incontinence. CONCLUSIONS: With these results, we could conclude that open, transvaginal or laparoscopic Burch operations were effective and safe for SUI with no significant differences of efficacy according to approach methods.

Comparison of Extraperitoneal Laparoscopic Burch Operation versus Raz Operation for Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: Results of extraperitoneal laparoscopic bladder neck suspension(BNS) and that of Raz procedure for the correction of stress urinary incontinence (SUI) were analyzed retrospectively. MATERIALS AND METHODS: Among 39 patients who underwent laparoscopic BNS for anatomical SUI, 28 patients had follow-up study at postoperative 6 months. All 87 patients who underwent Raz procedure were also followed up at postoperative 6 months. RESULTS: Mean operation time in laparoscopic BNS was 138 min initially but, was shortened to 95 min. after using 'thick (5 mm) knot pusher'; whereas mean operation time in Raz group was 56min. Return to normal voiding and mean duration of hospital stay were possible in 1.2 days and 2.6 days in laparoscopic group and 11.9 days and 4.5 days in Raz group with significant difference between 2 groups. Amount of residual urine at discharge was less than 100cc In all except 1 case in laparoscopic group(27/28, 96%). However in Raz group, 35 patient(40%) still showed residual urine of more than 1 00ml at the time of discharge. Postoperatively, voiding difficulty was noted in 3, frequency in 15, bleeding in 2, dyspareunia and bladder stone in 1 case for Raz group; In laparoscopic group, frequency was noted in 3, voiding difficulty in 2, needs of transfusion in 2 cases. 26 of 28 patients(85%) were completely dry or Improved in laparoscopic group; 82 of 87 patients(93%) In Raz group also showed complete dryness of improvement without significant difference in success rate between 2 groups. CONCLUSIONS: From our results, laparoscopic bladder neck suspension could shorten the duration of hospital stay and time to regaining normal voiding with early catheter removal. High success rate was also comparable to those of Raz operation. Laparoscopic BNS could applies as erective treatment modality for the surgical correction of anatomical stress urinary incontinence with its less invasiveness and early return to normal activities compared with the Raz procedure.