Review
Michelle L. Matthews, M.D., Carolinas Medical Center

This was a prospective, randomized study in 52 women comparing a laparoscopic Burch colposuspension to a Burch colposuspension performed by laparotomy for genuine stress urinary incontinence (GSI). Complete evaluations were performed prior to randomization and included multi-channel urodynamics and measurement of leak-point pressure. Patients in both groups were similar in age, parity and menopausal status. There was a fairly equal distribution of patients having other gynecologic (GYN) procedures done at the time of the Burch colposuspension (hysterectomy, posterior colporrhaphy, tubal ligation, salpingo-oopherectomy, cyst excision). The Burch procedures were performed in both the laparoscopic and laparotomic approach by fixation of the vaginal fascia against Cooper’s ligament with two sutures on each side of the urethra. Post-operative variables analyzed include age, surgical time, length of catheterization, number of days in the hospital and complications. Continence was evaluated both subjectively by history and questionnaire, as well as objectively by multi-channel urodynamic evaluation and Q-tip tests repeated 3 months after the surgery.

Results demonstrated increased valsalva leak-point pressures in both groups reaching statistical significance in the laparoscopic group. There were no statistical differences in other urodynamics. The mean operating time in the laparoscopic group was longer than in the laparotomy group (90 min. vs 60 min.). However, the laparoscopic group required significantly shorter hospitalization (2 days vs 6.5 days). The success and complication rates were similar in both groups. The most common complications were detrusor instability and urinary retention. In both groups, incontinence was cured in 80.8% by 3 months and remained so at 12 months. In summary, this study reported that a Burch colposuspension performed laparoscopically is as effective for improving GSI as by laparotomy with the additional benefit of less hospital stay.

Comments 
Daniel B. Williams, M.D., Cincinnati, OH

This study compared the Burch procedure via laparoscopy versus laparotomy, in patients who were undergoing a concomitant GYN procedure. While this was a prospective, randomized trial, the numbers were relatively small. Success rates and overall complication rates were similar in both groups. However, intraoperative complications were higher in the laparoscopic group (7.6%) versus the laparotomy group (3.8%). This would underscore the need for advanced laparoscopic skills to make this a viable procedure. As would be anticipated, the laparoscopic group had a longer operating time and a shorter hospital stay when compared to the group undergoing laparotomy. It is difficult to determine what effect, if any, concomitant gyn surgery had on the operating time in this study. Therefore, based on these study findings, patients with GSI who require a Burch procedure in addition to another GYN procedure can undergo either laparoscopy or laparotomy depending on the experience of the surgeon as well as the specific surgical requirements of the concomitant GYN procedure.  

You may also want to visit Highlights from Fertility and Sterility taken from the ASRM medical journal and ASRM Journal Highlights to read summaries of current articles from other medical journals in the field of reproductive medicine. 

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