Abstract
Video Objective To demonstrate a minimally invasive technique to the Burch procedure for treatment of stress urinary incontinence as an alternative therapeutic modality for women who do not want or cannot have mesh products. Setting Surgical intervention for a 68 yo G12 P10-0-2-10 with prolapse and stress urinary incontinence (SUI). After undergoing appropriate counseling and discussion regarding risks, benefits and alternatives the patient and family declined use of mesh products for any portion of the repair. The decision was made to proceed with a hysterectomy, uterosacral colpopexy and Burch colposuspension. Preoperative optimization of her health and multiple co-morbidities required a multidisciplinary approach. Blood pressure control, diabetes and thyroid management as well as topical estrogen treatment of vaginal epithelium for 3 months prior to surgery. Interventions Robotic colposuspension for genuine SUI following a robotic hysterectomy and uterosacral colpopexy. The procedure took 62 minutes to complete, the blood loss was minimal and there were no complications. She was observed overnight, had a successful voiding trial in the morning and was discharged shortly after. Follow up at 2 and 6 weeks after surgery she reported no pain and no complications. She reports significant improvement in bladder function and bladder control. Conclusion The Burch procedure is well known as an effective treatment for SUI but generally not frequently performed due to morbidity associated with laparotomy requiring procedures and the availability of less invasive approachesmsuch as a transvaginal suburethral sling. With the minimally invasive surgery evolution being inclusive of nearly all gynecologic procedures, a robotic or laparoscopic Burch colposuspension as an alternative to transvaginal suburethral sling with mesh should be considered. This videos demonstrates a reproducible, safe and efficient approach to this procedure.
Published Version
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