A 5-year follow-up study comparing Burch colposuspension and transobturator tape for the surgical treatment of stress urinary incontinence

The Efficacy of Modified Laparoscopic Burch Procedure Using a Single Stitch on Each Side of the Urethra for the Treatment of Stress Urinary Incontinence

Background and Objectives: This study aimed to evaluate the efficacy and safety of modified laparoscopic Burch intervention over a 24-month follow-up period. Materials and Methods: We performed a retrospective cohort evaluation including all eligible patients, 83 patients, who underwent modified laparoscopic Burch colposuspension for stress urinary incontinence (SUI). Primary outcomes included the presence or absence of SUI on follow-up and the success of index surgery based on responses to validated questionnaires of patient-reported outcomes. Results: Patient-reported outcomes indicated a progressive improvement in perceived well-being over time. At the 6-month follow-up, 50.6% of participants reported their condition as "greatly improved", increasing cumulatively to 66.7% by 24 months. The severity of urinary incontinence symptoms was markedly reduced following the intervention. The incidence of severe incontinence was notably low, with only 4.8% of patients affected at 6 months, remaining consistent at 5.1% at 24 months. This finding aligns with a high procedural success rate, as the vast majority of patients (≥94.9%) reported no severe symptoms across all follow-up intervals. Dryness, defined as the absence of urinary leakage, demonstrated an upward trend over time. At 6 months, 45.8% of patients reported complete dryness, with this figure rising to 55.1% at 12 months and 62.8% at 24 months. The Urogenital Distress Inventory-6 (UDI-6) served as a critical metric for evaluating the subjective burden of urinary symptoms. Across all follow-up intervals, over 97% of patients achieved scores below the clinically significant threshold (<33), indicating substantial symptom relief and enhanced quality of life. Conclusions: The modified laparoscopic Burch colposuspension demonstrated consistent efficacy, with significant improvements in urinary continence, symptom severity, and quality of life over the 24-month follow-up period.

Evaluating Patient Preferences and Clinical Outcomes in Stress Urinary Incontinence Treatment: A Short-Term Follow-Up Study of the Transobturator Tape Procedure and Pubourethral Ligament Plication (a Minimally Invasive Technique)

OBJECTIVE

This study aims to provide an in-depth analysis of patient preferences and clinical outcomes associated with two surgical techniques for treating stress urinary incontinence (SUI): the transobturator suburethral sling (TOT) procedure and the pubourethral ligament plication (PUL) procedure. We evaluated the rates of postoperative complications, the duration of each procedure, hemoglobin loss, and days of hospitalization.

MATERIALS AND METHODS

This prospective study included 80 patients who underwent surgery for SUI: 40 patients for the TOT procedure and 40 patients for the PUL procedure. Clinical data on patient characteristics, treatment efficacy, and post-surgical outcomes were analyzed to assess patient preferences and real-world clinical effectiveness.

RESULTS

Regarding patient preferences, those who underwent TOT surgery were more likely to be older, had a higher average number of pregnancies, and were more often postmenopausal, in contrast to those who underwent PUL surgery (p < 0.001 for each comparison). TOT patients had a hospital stay on average of 1.02 days, while PUL patients benefited from ambulatory stays only. In addition, the TOT group had a significantly longer average operating time (16.80 min) compared to the PUL group (9.90 min, p < 0.001). The study revealed notable outcomes in both groups, with high cure rates for both TOT (N1 = 33, 82.5%) and PUL (N2 = 28, 70%) procedures. Specifically, 76.25% of the patients (61 out of 80) were cured after the procedures. Chronic pelvic pain was present in 3.75% of all patients and was notably only observed in the TOT group, with 3 (7.5%) cases being noted. Similarly, vaginal erosion was experienced by 5% of all patients, with 10% of patients in the TOT group and none in the PUL group being affected. Dyspareunia occurred in 2.5% of all patients, with there being two (5%) cases in the TOT group and none in the PUL group.

CONCLUSIONS

This study highlights that while the PUL procedure achieves cure rates comparable to TOT, it offers a less invasive option with shorter operating times and no hospitalization required. These findings suggest that PUL could be a viable alternative for stress urinary incontinence (SUI) treatment, especially in contexts where avoiding mesh use is preferred. This adds significant value to patient-centered care in SUI management, offering tailored treatment options based on patient characteristics, preferences, and risk profiles.

Modification of bladder thermodynamics in stress urinary incontinence patients submitted to trans-obturator tape: A retrospective study based on urodynamic assessment

Importance: It needs to be clarified whether trans-obturator tape (TOT)-enhanced urethral resistance could impact the voiding function.

Objective: Although TOT has been well-recognized for enhancing urethral resistance to restore continence in stress urinary incontinence (SUI) patients, whether the bladder’s voiding functions adapt to the TOT-enhanced resistance has not been adequately investigated. This study thereby aimed to investigate whether TOT impacts the bladder’s thermodynamic efficacy during the voiding phase.

Design: A retrospective analysis of urodynamics performed before and after TOT was assessed.

Setting: A tertiary referral hospital in Taiwan.

Participants: A total of 26 female SUI patients who underwent urodynamic investigations before and after TOT.

Main outcomes and measures: The area enclosed by the pressure-volume loop (Apv), which represents the work performed by the bladder during voiding, in a pressure-volume analysis established by plotting the detrusor pressure versus intra-vesical volume was retrospectively analyzed. Paired Student’s t-tests were employed to assess the difference in values before and after the operation. Significance in difference was set at p &lt; 0.05.

Results: TOT increased Apv in 20 of 26 (77%) patients and significantly increased the mean Apv compared to the preoperative control (2.17 ± 0.18 and 1.51 ± 0.13 × 103 cmH2O-ml, respectively p &lt; 0.01). TOT also increased the mean urethral resistance (1.03 ± 0.30 vs. 0.29 ± 0.05 cmH2O-sec/ml, p &lt; 0.01) and mean voiding pressure (25.87 ± 1.72 and 19.30 ± 1.98 cmH2O p &lt; 0.01) but did not affect the voided volume and voiding time. Moreover, the TOT-induced Apv increment showed a moderate correlation with the changes in urethral resistance and voiding pressure (both r &gt; 0.5) but no correlation with changes in voided volume or voiding time. It is remarkable that the TOT-induced urethral resistance increment showed a strong correlation with changes in voiding pressure (r &gt; 0.7).

Conclusion and Relevance: The bladder enhances thermodynamic efficacy by adapting the voiding mechanism to increased urethral resistance caused by TOT. Further studies with higher case series and longer follow-ups should assess whether this effect could be maintained over time or expire in a functional detrusor decompensation, to define diagnostic criteria that allow therapeutic interventions aimed at its prevention during the follow-up.

Clinical Trial Registration: (clinicaltrials.gov), identifier (NCT05255289)

Laparoscopic and open burch colposuspension for stress urinary incontinence: advantages and disadvantages

OBJECTIVE

Stress urinary incontinence (SUI) causes a significant physical and psychological burden on women. The laparoscopic vaginal suspension (LC), used in the treatment of women with SUI, is known for its advantages such as smaller incisions, short hospital stays, and better aesthetic results. This article throws light upon the advantages and disadvantages of LC and open Burch vaginal (OC) incontinence along with its associated complications.

PATIENTS AND METHODS

Between December 1, 2017 and February 10, 2019, 26 women with SUI with physical, social, and psychological consequences from two hospitals were enrolled in this study. The sample was divided into two equal groups of 13 women each. Data were collected and statistically analyzed. P ≤ 0.05 is statistically significant.

RESULTS

The study showed that the operational time was significantly shorter in the OC method compared to the LC approach (59.2 ± 5.3 min and 91 ± 4.5 min, respectively). Mean blood loss was higher in the OC approach than in the LC approach (152.2 ± 30.3 and 143.3 ± 38.6, respectively). The LC approach has minimal pain and a shorter hospital stay compared to the OC approach. Patients with the LC approach required less analgesia (8.9 ± 1.3 mg vs 2.5 ± 1.8 mg) and less hospital stay (110.3 ± 11.4 h vs 70.2 ± 8.9 h) after surgery. Resumption of normal activity was faster in the LC approach [25.1 ± (12.6) days, 18.9 ± (12.5) days] than in the OC approach. There was no significant difference between the OC and LC approaches in terms of complications.

CONCLUSIONS

Although LC is a superior and less invasive approach than the OC approach in terms of hospital stay, blood loss, pain, and recovery time, the operation time is longer.

Burch Procedure: A Historical Perspective

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.

The practice of Burch Colposuspension versus Mid Urethral Slings for the treatment of Stress Urinary Incontinence in developing country

OBJECTIVES

To compare the effectiveness and complications of Burch colposuspension and Mid Urethral Slings (MUS) for the treatment of Stress Urinary Incontinence (SUI).

METHODS

We conducted a cross-sectional study of 162 patients who underwent surgery for SUI with Burch colposuspension (n=40), tension free vaginal tape (TVT) (n= 59) or transobturator tape (TOT) (n=63), from 2006 to 2014 at the Aga Khan University Hospital- Karachi. All three groups were assessed in terms of demographics, cure rates, intraoperative and postoperative complications at one and five years using incontinence impact questionnaire-short form-7 (IIQ-7) and urogenital distress inventory -short form-6 (UDI-6).

RESULTS

Mean age of the participants in Burch, TVT and TOT group was 44.1 ± 7.4, 48.3 ± 8.9, 53.0 ± 9.4 respectively. Majority of patients in TVT group were premenopausal (59.3%) and postmenopausal in TOT group (53.9%). Most abdominal hysterectomies were done in Burch group (40) while vaginal hysterectomies and anterior and posterior colporrhaphy in TOT group (55). All the procedures had both subjective and objective cure rate of more than 82% at one year, with TVT having the highest success rate of 96.61%. The objective cure rate in Burch, TVT and TOT group at five years was 74.19%, 90.30% and 81.25% respectively. Intraoperative complications included hemorrhage in one patient during Burch procedure and bladder perforation in two cases of TVT, with no significant difference in short or long-term complications with either procedure.

CONCLUSIONS

All the three procedures have equal efficacy and complication rates. Even though TVT is the new gold standard but in view of current debate regarding mesh related complications, there is a need to readdress Burch colposuspension for treatment of SUI.

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

PURPOSE

Women with stress urinary incontinence (SUI) often require combined pelvic reconstructive surgeries because of shared risk factors of pelvic organ prolapse. The purpose of this study was to evaluate efficacies of Burch colposuspension, 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 performed this retrospective cohort study that comprising 122 patients who either underwent Burch colposuspension (n:43), TOT (n:40), or SIS (n:39) procedures along with pelvic reconstructive surgery or hysterectomy between January 2010 and July 2018. During the clinical follow-up, we analyzed cure rates, and surgical success rates of SUI surgery, quality of life, and symptom severity by IIQ-7, UDI-6, SSI, SSQ-8, OAB-V8, and PGI-I scale scores. The primary outcome was surgical success, whereas secondary outcomes included complications and patient-reported outcomes in the quality of life.

RESULTS

We found that surgical success rates were higher in Burch group than SIS group and higher in TOT group than in SIS group (88.4% vs 61.5% and 87.5% vs 61.5%, p = 0.003). The quality of life was lower in SIS group than in Burch group.

CONCLUSIONS

Both Burch and TOT are effective procedures in patients with SUI who require additional pelvic surgeries. Although surgical outcomes of SIS procedure in patients with SUI who underwent concomitant pelvic surgeries in our study were not promising, further studies with SIS are needed to clarify these observations.

Which Anti-Incontinence Surgery Option is Better in Patients Undergoing Total Laparoscopic Hysterectomy? Burch Colposuspension or Transobturator Tape Procedure

OBJECTIVES

Stress urinary incontinence (SUI) surgery and hysterectomy are often performed in the same session. The aim of this study was to determine which urinary incontinence surgery would be a better option for patients who would undergo a hysterectomy for various indications.

STUDY DESIGN

This retrospective study included 65 patients who had undergone total laparoscopic hysterectomy and anti-incontinence surgery (TOT or Burch).A retrospective chart review was performed to record the patient data including demographic features, duration of operations, postoperative complete blood count values and post-void residual urine volumes. ICIQ-UI and UDI-6 interrogations related to urinary incontinence were compared pre- and postoperatively between two groups.

RESULTS

There was no difference in demographic characteristics and menopausal status between groups. No significant difference was found between two groups in postoperative period for urinary incontinence scores (p>0,05). When the duration of operation was compared, the duration was significantly higher in the TOT group. And the hematocrit drop in the group with TOT was significantly higher (p<0.05).

CONCLUSIONS

Because the success rates of Burch colposuspension and transobturator procedures are similar, either of these two methods can be selected according to patient characteristics and surgeon experience. But Burch colposuspension seems to be more preferable in terms of blood loss and operation time than TOT.

Will future doctors know enough about stress urinary incontinence to provide proper preventive measures and treatment?

Background: Stress urinary incontinence (SUI) is an embarrassing condition, which is one of the last taboos in modern medicine. The study aim was an attempt to assess medical students' knowledge of female stress urinary incontinence.Methods: The study involved 432 students of the Medical Department at the Medical University of Silesia in Katowice. Participants answered open-ended questions about: risk factors, prevention, diagnostic tests, conservative and surgical treatment in stress urinary incontinence.Results: The obtained results indicated that female students know more about SUI than male students. Women - more often than men - could provide the definition of SUI (p < 0.01); additionally, they more frequently indicated prevention methods (p < 0.01), diagnostic testing (p < 0.001) and conservative methods of treatment (p < 0.001). Not all the respondents were able to properly define stress urinary incontinence. Risk factors were known to most of the respondents but only half of them were aware of surgical treatment and prevention methods. Even fewer answered questions about conservative treatment and diagnostic tests correctly.Conclusions: We conclude that the knowledge of medical undergraduates who took part in the survey was not satisfactory. Most of the students were able to define properly the disease and point out risk factors. However, several steps should be taken to make stress urinary incontinence a disease much more known to medical students.Abbreviations: SUI: Stress urinary incontinence; Group F: Females Group; Group M: Males Group; TVT: Tension Free Vaginal Tape; TOT: Transobturator Tape.

Long-term outcomes of TOT and TVT procedures for the treatment of female stress urinary incontinence: a systematic review and meta-analysis

INTRODUCTION AND HYPOTHESES

One of the most relevant topics in the field of pelvic floor dysfunction treatment is the long-term efficacy of surgical procedures, in particular, the use of prosthesis. Hence, a systematic review and meta-analysis was conducted to evaluate the long-term effectiveness and safety of midurethral sling (MUS) procedures for stress urinary incontinence (SUI), as reported in randomised controlled trials (RCTs) and non-randomised studies.

METHODS

This systematic review is based on material searched and obtained via PubMed/Medline, Scopus, and the Cochrane Library between January 2000 and October 2016. Peer-reviewed, English-language journal articles evaluating the long-term (≥5 years) efficacy and safety of MUS in women affected by SUI were included.

RESULTS

A total of 5,592 articles were found after the search, and excluding duplicate publications, 1,998 articles were available for the review process. Among these studies, 11 RCTs (0.6%) and 5 non-RCTs (0.3%) could be included in the qualitative and quantitative synthesis. Objective and subjective cumulative cure rates for retropubic technique (TVT) and transobturator tape (TOT; both out-in and in-out) were 61.6% (95% CI: 58.5-64.8%) and 76.5% (95% CI: 73.8-79.2%), and 64.4% (95% CI: 61.4-67.4%) and 81.3% (95% CI: 78.9-83.7%) respectively. When considering TOT using the out-in technique (TOT-OI) and TOT using the in-out technique (TVT-O) the objective and subjective cumulative cure rates were 57.2% (95% CI: 53.7-60.7%) and 81.6% (95% CI: 78.8-84.4%), and 68.8% (95% CI: 64.9-72.7%) and 81.3% (95% CI: 77.9-84.7%) respectively. Furthermore, this article demonstrates that both TVT and TOT are associated with similar long-term objectives (OR: 0.87 [95% CI: 0.49-1.53], I 2 = 67%, p = 0.62) and subjective (OR: 0.84 [95% CI: 0.46-1.55], I 2 = 68%, p = 0.58) cure rates. Similarly, no significant difference has been observed between TTOT-OI and TVT-O) in objective (OR: 3.03 [95% CI: 0.97-9.51], I 2 = 76%, p = 0.06) and subjective (OR: 1.85 [95% CI: 0.40-8.48], I 2 = 88%, p = 0.43) cure rates. In addition, this study also shows that there was no significant difference in the complication rates for all comparisons: TVT versus TOT (OR: 0.83 [95% CI: 0.54-1.28], I 2 = 0%, p = 0.40), TOT-OI versus TVT-O (OR: 0.77 [95% CI: 0.17-3.46], I 2 = 86%, p = 0.73).

CONCLUSIONS

Independent of the technique adopted, findings from this systematic review and meta-analysis suggest that the treatment of SUI with MUS might be similarly effective and safe at long-term follow-up.

Five-year follow-up study of Monarc transobturator tape for surgical treatment of primary stress urinary incontinence

INTRODUCTION AND HYPOTHESIS

We hypothesized that transobturator tape (TOT) is safe and efficacious for the treatment of urodynamic stress incontinence in the long term.

METHODS

We conducted a prospective study of patients with confirmed urodynamic stress incontinence (USI) who underwent a Monarc^TM TOT procedure in a tertiary center between February 2006 and March 2009 without other concurrent surgical procedures. Urodynamics were conducted at 1 and 3 years postoperatively. Subjective evaluation included Incontinence Impact Questionnaire (IIQ-7), Urinary Distress Inventory Questionnaire (UDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Objective cure was defined as no urinary leakage demonstrable on provocative filling cystometry and/ or 1-h pad test of <2 g. Subjective cure was based on a negative response to question 3 in UDI-6. Paired-samples t test, chi-square, and Fisher exact tests were applied; p < 0.05 was considered significant. The log-rank tests were used to compare event-free survival.

RESULTS

Sixty patients were enrolled, and 56 were evaluated at 5 years postoperatively. The majority were middle aged, postmenopausal, and overweight. Mean operating time was 31.1 ± 8.9 min, intraoperative complications were minor, and median period of follow-up was 80.3 ± 9.6 months. At 5 years of follow-up, objective and subjective cure rates were 89.3 % and 87.5 %, respectively. No mesh-related complications were seen. One patient needed a repeat midurethral sling procedure, and one patient each had bladder and bowel cancer.

CONCLUSION

Monarc TOT was safe and retained its high cure rate in the short- and long-term treatment of stress urinary incontinence.

Long Term Patient Satisfaction of Burch Colposuspension with or Without Concomitant Total Abdominal Hysterectomy

INTRODUCTION

Urinary incontinence negatively affects the quality of life. Various methods are used in the treatment of stress incontinence. Burch colposuspension (BC) is the classical treatment of urinary incontinence.

AIM

To compare the long-term satisfaction in patients receiving BC with or without concomitant total abdominal hysterectomy.

MATERIALS AND METHODS

One hundred and twenty patients with stress incontinence underwent burch colposuspension with or without concomitant total abdominal hysterectomy. Ninety-three (77.5%) patients were interviewed by telephone. Of these, 91(75, 8%) patients agreed to participate in the study. The patients were divided into two groups according to the type of the surgical procedure. Group 1(N=48, 52.7%) had received burch colposuspension with concomitant total abdominal hysterectomy. Group 2 (N=43, 47.3%) had received burch colposuspension without concomitant total abdominal hysterectomy.

RESULTS

In Group 1, 41 patients (85%) were satisfied with the surgery and did not complain of urinary incontinence (p<0.05). In Group 2, 37 (86%) patients were satisfied with the surgery (p<0.05).

CONCLUSION

There were no difference in patient satisfaction between hysterectomy and BC and only BC to treat incontinence.

Outcomes of Transobturator Tape Surgery with Safyre T® Slings for Female Stress Urinary Incontinence after 96 Months of Follow-Up

BACKGROUND/AIMS

To report the outcomes of transobturator tape (TOT) surgery with Safyre T® (Promedon, Argentina) slings for female stress urinary incontinence (SUI) at a 96- month follow-up.

METHODS

We conducted a clinical follow-up study of 153 patients diagnosed with SUI between January 2005 and December 2014. Patients were provided with detailed a priori information pertaining to the TOT procedure and were invited to attend follow-up visits at 1, 3, 12, 24, 48, 72 and 96 months. Follow-up visits included physical examination involving sling palpation, checking of the vaginal mucosa for erosion, cough test, as well as validated Urinary Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7) questionnaires.

RESULTS

The overall objective success rates, based on cough test results, were 91.3% at 12 months, 86.8% at 48 months and 77.6% at 96 months. Similarly, the overall subjective success rate, based on the validated UDI-6 and IIQ-7 scales, was 77.6% at 96 months.

CONCLUSION

The cure rates achieved, following TOT treatment of SUI at 1-year follow-up, showed a statistically significant decline over an 8-year period, especially at months 48 and 96. © 2015 S. Karger AG, Basel.

TOT approach in stress urinary incontinence (SUI) - outcome in obese female

BACKGROUND

Only limited data are available on the outcome of tension-free obturator tape (TOT) procedures in overweight and obese women. We would like to verify the objective and subjective outcomes of TOT in women with a higher body mass index (BMI).

METHODS

We evaluated the records of 116 patients who had undergone TOT, stratifying by BMI into normal weight (n = 31), overweight (n = 56), and obese (n = 29) groups. We compared pre- and postoperative evaluations, including subjective and objective outcome of TOT, complications, and quality of life assessed by validated questionnaires (ICIQ-SF and KHQ).

RESULTS

The median follow-up was 21 months. There were no significant differences between different groups in terms of objective cure rate and subjective success, quality of life scores and postoperative complications.

CONCLUSIONS

Our data demonstrate that TOT procedure is safe and effective. BMI did not influence the outcome of TOT procedures at a median of 21 months after surgery and represents no contraindication for continence surgery. The success of the outcome of TOT procedure in females and the occurrence of complications are not negatively affected by obesity.