Laparoscopic colposuspension

Burch colposuspension

Aims

To evaluate the historic and pathophysiologic issues which led to the development of Burch colposuspension, to describe anatomic and technical aspects of the operation and to provide an update on current evidence.

Methods

We have performed a focused literature review and have searched the current available literature about historic dimension, technical descriptions, and efficacy of Burch colposuspension.

Results

Burch colposuspension, performed either by an open or a laparoscopic approach, is an effective surgical treatment for stress urinary incontinence.

Conclusions

In current recommendations, Burch colposuspension remains an option for secondary treatment. Because midurethral slings have recently become under scrutiny, it may return as a first‐line treatment procedure. Both open and laparoscopic Burch colposuspension should therefore nowadays be provided in fellowship programs worldwide.

Suprapubic catheterisation: A retrospective comparison of two insertion systems

Abstract This study compares two suprapubic catheter insertion systems available for postoperative bladder drainage. We performed retrospective analysis of patients who underwent laparoscopic colposuspension and postoperative suprapubic catheterisation with either the Bonanno (Becton, Franklin Lakes, NJ, USA) or the Lawrence Add-a-Cath (Femcare, Nottingham, UK) mini-Foley catheters (Bard, Covington, GA, USA). There were no statistically significant postoperative outcome differences between the two catheter groups. We prefer the Add-a-Cath mini-Foley suprapubic catheter for its ease of insertion and fixation.

Laparoscopic colposuspension using sutures or prolene meshes: a 3-year follow-up

OBJECTIVE(S)

To compare the long-term effectiveness of two different laparoscopic colposuspension procedures.

STUDY DESIGN

Sixty women affected by genuine stress incontinence (GSI) were enrolled in a prospective randomized controlled trial (RCT) and treated by transperitoneal laparoscopic colposuspension using nonabsorbable sutures (group A) or prolene mesh fixed with tackers or staplers (group B). In each group the subjective and objective failure rates were evaluated at 12, 24, and 36 months after surgery. For the subjective evaluation patients were asked whether they had experienced urine leakage and any urine loss they reported was recorded on a visual analogue scale (VAS). The objective evaluation was performed by means of a clinical examination and multichannel urodynamic studies. The data were analyzed by the intention-to-treat method.

RESULTS

The subjective failure rate was significantly (P < 0.05) lower in group A than in group B at 12 months (3.3% versus 13.3%, respectively), 24 months (20.0% versus 36.7%, respectively), and 36 months (33.3% versus 53.3%, respectively) after surgery. The objective failure rate also differed significantly (P < 0.05) between the two groups after 12 (10.7% versus 25.0% for group A and group B, respectively), 24 (29.6% versus 57.7%, respectively), and 36 (42.3% versus 61.5%, respectively) months of follow-up.

CONCLUSION(S)

Laparoscopic colposuspension performed with sutures is more effective than laparoscopic colposuspension accomplished with the use of prolene meshes in the long term, and the use of prolene meshes should be avoided in treatment of GSI.

Anatomic comparison between laparoscopic and open Burch colposuspension for primary stress urinary incontinence

OBJECTIVES

To examine the anatomic results after laparoscopic and open Burch colposuspension for primary stress urinary incontinence.

METHODS

A cohort study was conducted of patients treated during a 7-year period, predominantly with an open Burch procedure for the first 2.5 years and laparoscopy thereafter. The actual suspension technique, including placement of sutures and the degree of tension for suspension of the bladder neck, was the same in both the laparoscopic and the open Burch colposuspension procedures. Ultrasound cystourethrography was used to assess the preoperative and postoperative bladder neck positions.

RESULTS

A total of 157 patients were identified and constituted the study groups: 75 who had undergone laparotomy (open group) and 82 who had undergone laparoscopy (laparoscopic group). No statistically significant differences were present in demographics, preoperative anatomic position, or urodynamic findings between the two groups. The laparoscopic group required significantly more posterior colporrhaphy procedures than did the open group (P <0.001). The subjective success rate at 1 year of follow-up for the laparoscopic and open groups was 89% and 84%, respectively. No statistically significant differences were found between the two groups in the resting and straining bladder neck positions or in urethral mobility at 1, 3, 6, and 12 months after the Burch operation. In both groups, a trend was noted that the urethrovesical support decreased with time.

CONCLUSIONS

The results of our study showed that, as long as an identical technique is used for suspension of the urethrovesical junction in Burch colposuspension, the clinical results with either an open or a laparoscopic approach are essentially the same.