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.

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.