Long-term results of laparoscopic Burch urethropexy

Abstract

We evaluated the long-term efficacy of laparoscopic Burch urethropexy performed in 35 consecutive women (average age 45.5 yrs, average weight 67.7 kg, average parity 2.3) between May 1992 and July 1994. Preoperative evaluations included cotton swab testing, urinalysis, dynamic urethrocystoscopy, and multichannel urodynamic testing. All subjects had genuine stress incontinence and a positive cotton swab test. Urethropexy was performed with curved needle suturing in 7 women, straight needle suturing in 5, and Stamey needle suturing in 23. Outcome variables were operative time, concomitant surgery, suture needle, length of hospital stay, need for catheterization, and subjective success. Women were divided into groups based on surgical success. Wilcoxon two-sample, chi2, and Fisher's exact tests were used to determine which variables were significantly associated with surgical success. Twenty-five women (71.4%) had concomitant pelvic surgery at the time of urethropexy. Average time of surgery was 190 minutes, length of stay 1 day, and length of time for catheterization 5 days. The cure rate of stress incontinence was 89% at 3 months and 86% at 1 year. At an average follow-up of 30 months, only 68.6% of women reported complete or almost complete cure, 11.4% were improved, and 20% were complete failures. The only variable approaching statistical significance for predicting surgical success was type of suture needle used (p = 0.07), with the Stamey needle group having the highest cure rate. The success rate of laparoscopic Burch urethropexy compares with that of open Burch procedure at 1 year but drops considerably thereafter.