Since the introduction of the retropublic urethral suspension in 1910, over 100 different surgical techniques for the treatment of genuine stress urinary incontinence (GSUI) have been described. Despite the number of surgical procedures developed each year, the Burch Colposuspension and pubo-vaginal sling operations have remained the mainstay of surgical correction for GSUI because of their high long-term cure rates. Doctors Miklos and Moore offer a laparoscopic approach to anterior wall reconstruction using the paravaginal repair and Burch Colposuspension for treatment of cystocele and stress urinary incontinence, resulting from lateral vaginal wall support defects.
Burch coloposuspension is used to treat urinary stress incontinence. Stress urinary incontinence is the involuntary leakage of urine during periods of increased intra-abdominal pressure, including exertion such as laughing, coughing, sneezing, and jumping.
In a continent individual, increased abdominal pressure is evenly distributed over the bladder, bladder neck, and urethra. The urethral sphincter is thus able to withstand this pressure and maintain continence. IN a person with pure STI, either the urethra is hypermobile or the sphincter is intrinsically deficient. In urethral hypermobility, the urethral vesicular junction (UVJ) is displaced extra-abdominally, and the increased intra-abdominal pressure is unevenly distributed such the that the sphincter can no longer withstand the pressure and urine leaks. With intrinsic sphincter deficiency (ISD), the UVJ is not hypermobile; however, the maximal urethral closing pressure, the Valsalva leak-point pressure, or both are too low to withstand the increase in intra-abdominal pressure and, thus, urine leaks past the sphincter.
The Burch procedure was described in 1961. Initially, Burch described attaching the paravaginal fascia to the arcus tendineus. However, he later changed the point of attachment to Cooper’s ligaments because these were felt to provide more secure fixation points, and less chance of infection as seen with prior procedures.
Although its durability has been proven, the open repair is less commonly performed due to the advent of less invasive procedures. However, a role for this procedure remains when concomitant open surgery is planned in conjunction with surgical correction of stress urinary incontinence. Laparoscopic surgeons have also demonstrated that the repair can be performed via a laparoscopic approach, decreasing morbidity, while still providing a satisfactory outcome.
Patients requiring concomitant abdominal surgery that cannot be performed vaginally is a candidate for an open Burch coloposuspension. The Burch procedure can be preformed via open or laparoscopic approach. Historically, the Burch procedure was used when concomitant open surgery was being performed, and this can now be adjusted to accommodate a laparoscopic approach, which is what Doctors Miklos and Moore can perform.
Several cohort studies have shown similar cure rates between laparoscopic and open Burch coloposuspension. An objective cure rate of 89-98% with follow-up to 36 months has been reported in several case series.
A multicenter randomized trial comparing the pubo-vaginal sling using autologous rectus fascia and the Burch coloposuspension in 665 women demonstrated a higher success rate for treatment of stress urinary incontinence with the autologous fascial sling, but it was also associated with greater morbidity.
The Burch procedure has remained one of the top two surgeries in the treatment of stress urinary incontinence since the 1960’s. In 2008 and 2011 the FDA issued warnings on the use of Transvaginal meshes. Doctors Miklos and Moore have seen an increase in patients who request the Burch procedure. The patients who are asking for the Burch procedure are doing so specifically because they fear the potential complications associated with mesh slings.
Many patients think they are getting a bladder suspension when they receive treatment for female stress incontinence when in fact they are actually getting a urethral suspension. Drs. Miklos and Moore prefer to use a laparoscopic approach to the Burch procedure, whereas most surgeons cannot do the Burch procedure unless they make a large incision on the abdomen. Patients that undergo the laparoscopic Burch do not have to endure the severe postoperative pain and discomfort that is associated with the large abdominal incision known as a laparotomy.
Doctors Miklos and Moore have performed over 600 Burch procedures to date, and have very high cure rates (90 percent at one year and 85 percent at five years) reported from their patients. You do not have to suffer from urinary incontinence if you choose to have this procedure done; Doctors Miklos and Moore understand the difficulties and are experts in making you feel like your former self once again.