Burch colposuspension: long-term results and review of published reports

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Objectives. To review our long-term results with the Burch colpocystourethropexy, compare our results with those in recently published reports, and define factors that may influence the long-term outcome of this procedure. Methods. A group of 79 patients who underwent Burch colposuspension as modified by Tanagho between January 1985 and January 1991 were studied retrospectively. Preoperative investigation consisted of clinical history, physical examination, cystourethroscopy, multichannel urodynamic evaluation, including pressure-flow studies, and static and dynamic urethral pressure profile analysis. A postal survey was sent to all patients to evaluate their symptoms and the impact on their quality of life. Results. The mean follow-up was 7.6 years (range 5.3 to 10.8). Forty-four percent of patients were considered cured (responders), 25% significantly improved (partial responders), and 31% failures (nonresponders). The success rate was higher among patients who had not undergone previous continence surgery (75%) or hysterectomy (78%) than among those who had previously undergone continence surgery (59%) or hysterectomy (65%). Seventy-five percent of the patients were responders or partial responders if the bladder was stable preoperatively, as opposed to 70% when the bladder was unstable before surgery. Analysis of the postal questionnaire indicated a statistically significant difference in terms of irritative symptoms between the responder and partial responder groups combined and the nonresponder group. Conclusions. More than two thirds (69.6%) of our patients who underwent a Burch-Tanagho colpocystourethropexy had a favorable long-term outcome (mean 7.6 years). Previously failed continence procedures, unstable bladder preoperatively, and previous or concomitant hysterectomy had a negative influence on the final outcome in the long term from the clinical point of view, even if, statistically, the difference was not significant. The incidence of irritative symptoms and nocturia were significantly higher among nonresponders than among responders and partial responders. More attention paid to these symptoms during the postoperative follow-up should increase the perception of success by the patient after retropubic colpocystourethropexy.