What are the effectiveness and risks of Burch colposuspension for treating stress urinary incontinence associated with a high bladder neck?

Effectiveness and Risks of Burch Colposuspension for High Bladder Neck

Burch colposuspension remains a viable surgical option for stress urinary incontinence associated with a high bladder neck, with cure rates of 85-88% and a retention risk of 3% without prolapse treatment and 1% with prolapse treatment. 1

Effectiveness of Burch Colposuspension

• Short-term outcomes:

  • 91% of patients are cured or markedly improved at 2 years 2
  • 95% success rate when used as first-line surgical treatment 2
  • 82% success rate for recurrent stress urinary incontinence 2

• Long-term outcomes:

  • Time-dependent decline in effectiveness for 10-12 years, then plateaus at 69% 3
  • At 5-year follow-up, 78% of women report continence, 11% report improvement, and 11% report failure 4

Comparison with Other Surgical Options

Burch colposuspension has been largely supplanted by midurethral slings (MUS) in current practice 5, but remains an important option in specific circumstances:

• When synthetic mesh is contraindicated or concerning to patients 5
• When concurrent abdominal-pelvic surgery is planned 6
• When vaginal access is limited 6

The SISTEr trial showed that autologous fascial pubovaginal sling had better effectiveness and lower re-treatment rates compared to Burch colposuspension (66% vs 49%) 5.

Risks and Complications

Common complications of Burch colposuspension include:

• Immediate postoperative:

  • Fever (11%) 5
  • Urinary tract infection (15%) 5
  • Bladder injury (6%) 5
  • Temporary urinary retention (most common immediate postoperative complaint) 2

• Short to medium-term:

  • Voiding dysfunction (10%) 5
  • Urgency (19% at 6-12 months) 2
  • Mild voiding difficulties (9% at 6-12 months) 2

• Long-term:

  • Development of rectocele or enterocele (12% at one year) 2
  • De novo detrusor instability (14.7%) 3
  • Long-term voiding difficulty (22%) 3
  • Recurrent urinary tract infection (4.6%) 3

Risk Factors for Failure

Several factors can adversely affect the success of Burch colposuspension:

• Previous bladder neck surgery 3
• Pre-operative weight greater than 80 kg 3
• Intra-operative blood loss more than 1000 ml 3
• Development of post-operative detrusor instability 3

Laparoscopic vs. Open Approach

• Laparoscopic approach has lower risk of febrile complications (0%) and UTI (2%) compared to open approach 5
• However, ureteral injury rates are higher with laparoscopic approach (11%) compared to open approach (1%) 5, 1

Clinical Recommendations

1. Burch colposuspension should be considered for patients with stress urinary incontinence associated with high bladder neck when:

   • Patients are concerned about mesh use 5
   • Concurrent abdominal-pelvic surgery is planned 6
   • Vaginal access is limited 6

2. Patients should be informed that:

   • Failures typically appear within the first six months 2
   • Long-term follow-up (5-10 years) is necessary to assess sequelae 3
   • Effectiveness declines over time, with a plateau at 69% after 10-12 years 3

3. For patients with low urethral closure pressure, a vaginal sling procedure may be preferable to Burch colposuspension 4

4. Urodynamic evaluation should be performed preoperatively to confirm the diagnosis and guide treatment selection 4