What is Burch colposuspension (Burch procedure)?

From the Guidelines

Burch colposuspension is a viable surgical option for treating stress urinary incontinence in women, particularly those who cannot have mesh implants or are undergoing concurrent abdominal surgery, with a success rate of 85-90% initially, decreasing to about 70% after 5-10 years 1.

Key Points

• The procedure involves lifting and securing the bladder neck and urethra to the pubic bone using permanent sutures, which helps prevent urine leakage during physical activities.
• Burch colposuspension can be performed through an open abdominal incision or laparoscopically, with the latter offering shorter recovery time.
• Potential complications include difficulty emptying the bladder, new onset urge incontinence, pelvic pain, and rare risks of bleeding or infection.
• According to the AUA/SUFU guideline, Burch colposuspension is one of the recommended surgical options for stress urinary incontinence, along with midurethral slings and autologous fascial pubovaginal slings 1.
• A study comparing Burch colposuspension with autologous fascial pubovaginal sling found that the latter had lower re-treatment rates, with 66% of patients requiring re-treatment after Burch colposuspension compared to 49% after autologous fascial pubovaginal sling 1.

Considerations

• The choice of surgical procedure should be individualized based on the patient's symptoms, degree of bother, goals, and expectations, as well as the risks and benefits of each procedure.
• Burch colposuspension may be a better option for women who are concerned about the use of mesh or who are undergoing concurrent abdominal surgery.
• The success rate of Burch colposuspension decreases over time, with a reported success rate of 73% after 5-10 years 1.
• Common complications of Burch colposuspension include fever, urinary tract infection, bladder injury, and voiding dysfunction, with estimated rates of occurrence ranging from 3-15% 1.

From the Research

Burch Colposuspension Overview

• Burch colposuspension is a surgical procedure used to treat stress urinary incontinence (SUI) in women.
• The procedure involves suspending the vagina to the Cooper's ligament to support the urethra and prevent incontinence.

Efficacy of Burch Colposuspension

• A study published in 1995 2 found that 88% of women reported continence 2 months postoperatively, with a failure rate of 7%.
• A 2007 study 3 compared Burch colposuspension to fascial sling and found that the sling procedure had higher success rates for overall urinary incontinence measures (47% vs 38%) and stress incontinence measures (66% vs 49%).
• A 2021 study 4 compared open Burch colposuspension to retropubic midurethral sling and found no difference in success, patient satisfaction, or complications between the two procedures.

Long-term Results of Burch Colposuspension

• A 2013 study 5 found that laparoscopic Burch colposuspension improved quality of life and reduced symptoms of SUI in women, with significant improvements in questionnaire scores at 6 weeks, 6 months, and 18 months postoperatively.
• A 2022 study 6 found that Burch colposuspension was effective in treating SUI, with 68.4% of patients reporting absence of SUI symptoms and 73.6% reporting subjective satisfaction after a mean follow-up period of 14.2 years.

Complications and Safety

• The 2007 study 3 found that more women who underwent the sling procedure had urinary tract infections, difficulty voiding, and postoperative urge incontinence.
• The 2021 study 4 found that the risk of posterior compartment prolapse operations was increased after Burch colposuspension.
• The 2022 study 6 found that 28.1% of patients suffered at least one long-term postoperative complication, including dyspareunia, de novo overactive bladder, and voiding dysfunction.