Randomized Trial of Laparoscopic Burch Colposuspension Versus Tension-Free Vaginal Tape: Long-Term Follow Up

Abstract

A recent Cochrane review found that women with stress urinary incontinence (SUI) were less likely to leak on objective testing following the mid-urethral tension-free vaginal tape (TVT) procedure than after the laparoscopic Burch colposuspension operation. Subjective cure rates were similar, however, and postoperative follow-up was limited to 18 months. The present prospective randomized trial, carried out at an academic tertiary referral center, followed 72 women with urodynamic SUI who were randomly assigned to have the Burch operation or TVT procedure for a median of 65 months. Nearly three-fourths of the women were followed for 4 to 8 years. Patients completed the Incontinence Severity Index, Urogenital Distress Inventory, Incontinence Impact Questionnaire, and Patient Global Impression of Improvement scales. Somewhat more women having laparoscopic surgery (57% vs. 48%) reported any degree of urinary incontinence 4 to 8 years after surgery, for a relative risk of 1.19 (95% confidence interval, 0.71–2.0); the difference was not significant. Only 11% of women in the Burch group and 8% of those in the TVT group reported having bothersome incontinence after surgery. The group difference in rates of moderate to severe incontinence 4 to 8 years after surgery was not statistically significant. More than 65% of women in both groups reported being better or very much better than before surgery. Only 7% and 4%, respectively, felt that they were much worse or very much worse. In all, 4% of women were reoperated on for SUI. Comparable numbers of patients in the 2 groups were using pads or taking anticholinergic medication. Quality of life had improved significantly in both groups within 1 to 2 years after surgery, and this continued throughout follow-up. The investigators believe that the TVT procedure is about as effective as the laparoscopic Burch colposuspension operation in women with SUI. Although a substantial number of women has some degree of incontinence 4 to 8 years postoperatively, this is not bothersome to a majority of those affected.